Provider Demographics
NPI:1528192895
Name:AMBORN, SUSANN ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSANN
Middle Name:ELIZABETH
Last Name:AMBORN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSANN
Other - Middle Name:ELIZABETH
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:770 COLEMAN AVE
Mailing Address - Street 2:#K
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-322-1943
Mailing Address - Fax:
Practice Address - Street 1:1020 CORPORATION WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303
Practice Address - Country:US
Practice Address - Phone:650-962-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17127103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical