Provider Demographics
NPI:1588828347
Name:KANTHER-RAZ, SUSANNA NELL (PSYD, MS)
Entity Type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:NELL
Last Name:KANTHER-RAZ
Suffix:
Gender:F
Credentials:PSYD, MS
Other - Prefix:DR
Other - First Name:SUSANNA
Other - Middle Name:
Other - Last Name:KANTHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, MS
Mailing Address - Street 1:40 LAKE BELLEVUE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2479
Mailing Address - Country:US
Mailing Address - Phone:415-572-3803
Mailing Address - Fax:
Practice Address - Street 1:40 LAKE BELLEVUE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2479
Practice Address - Country:US
Practice Address - Phone:415-572-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22038103TC0700X
WAPY60475128103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical