Provider Demographics
NPI:1508989575
Name:SUSMAN, JANICE F (MFT)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:F
Last Name:SUSMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3346
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96160-3346
Mailing Address - Country:US
Mailing Address - Phone:530-582-4977
Mailing Address - Fax:530-587-1223
Practice Address - Street 1:10098 JIBBOOM ST
Practice Address - Street 2:SUITE 103
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0209
Practice Address - Country:US
Practice Address - Phone:530-582-4977
Practice Address - Fax:530-587-1223
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35809106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist