Provider Demographics
NPI:1619965290
Name:OROVITZ, SUSAN GALE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GALE
Last Name:OROVITZ
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 1:5151 N PALM AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2211
Mailing Address - Country:US
Mailing Address - Phone:559-226-5263
Mailing Address - Fax:559-226-6602
Practice Address - Street 1:5151 N PALM AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2211
Practice Address - Country:US
Practice Address - Phone:559-226-5263
Practice Address - Fax:559-226-6602
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10908103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL109080Medicare UPIN
CAOPL109080Medicare ID - Type Unspecified