Provider Demographics
NPI:1568558518
Name:STRONG, SYD SUSAN (PH D MFCC)
Entity Type:Individual
Prefix:MS
First Name:SYD
Middle Name:SUSAN
Last Name:STRONG
Suffix:
Gender:F
Credentials:PH D MFCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 SUTTER STREET
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707
Mailing Address - Country:US
Mailing Address - Phone:510-528-1235
Mailing Address - Fax:
Practice Address - Street 1:1521 A SHATTUCK AVENUE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707
Practice Address - Country:US
Practice Address - Phone:510-528-1235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21910101YA0400X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist