Provider Demographics
NPI:1598015893
Name:BOWEN, SUSAN (MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BOWEN
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 1:1820 OGDEN DR # 9
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-5384
Mailing Address - Country:US
Mailing Address - Phone:650-576-5690
Mailing Address - Fax:
Practice Address - Street 1:1820 OGDEN DR # 9
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-5384
Practice Address - Country:US
Practice Address - Phone:650-576-5690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48018106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist