Provider Demographics
NPI:1669000212
Name:LINDBLADE, SUSAN (LMFT, AT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LINDBLADE
Suffix:
Gender:F
Credentials:LMFT, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 JOLLY CT
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-6845
Mailing Address - Country:US
Mailing Address - Phone:415-302-6424
Mailing Address - Fax:
Practice Address - Street 1:1000 FREMONT AVE STE 200
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6055
Practice Address - Country:US
Practice Address - Phone:415-302-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103921106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist