Provider Demographics
NPI:1619038452
Name:BISHOP, SUE ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:ANNE
Last Name:BISHOP
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 1:2672 BAYSHORE PKWY STE 611
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-1017
Mailing Address - Country:US
Mailing Address - Phone:650-969-0288
Mailing Address - Fax:165-096-9028
Practice Address - Street 1:2672 BAYSHORE PKWY STE 611
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1017
Practice Address - Country:US
Practice Address - Phone:650-969-0288
Practice Address - Fax:165-096-9028
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13407103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical