Provider Demographics
NPI:1619991130
Name:SCHMALL, SUSAN RAHIMA JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RAHIMA JOAN
Last Name:SCHMALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RAHIMA
Other - Middle Name:
Other - Last Name:SCHMALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:4362 VILLAGE LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-1833
Mailing Address - Country:US
Mailing Address - Phone:707-318-4470
Mailing Address - Fax:707-318-4470
Practice Address - Street 1:1030 MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-2056
Practice Address - Country:US
Practice Address - Phone:707-318-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17236103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR13245Medicare UPIN
CAPSY17236Medicare ID - Type Unspecified