Provider Demographics
NPI:1609229996
Name:KLEINWAKSMEDCALF, SUEPEPI (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUEPEPI
Middle Name:
Last Name:KLEINWAKSMEDCALF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 SOLANO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2220
Mailing Address - Country:US
Mailing Address - Phone:510-207-4319
Mailing Address - Fax:
Practice Address - Street 1:1715 SOLANO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2220
Practice Address - Country:US
Practice Address - Phone:510-207-4319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling