Provider Demographics
NPI:1679854657
Name:FRIXIONE, SUSAN THOMAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:THOMAS
Last Name:FRIXIONE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 LEONA AVE
Mailing Address - Street 2:
Mailing Address - City:LEONA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93551-7432
Mailing Address - Country:US
Mailing Address - Phone:661-965-6954
Mailing Address - Fax:
Practice Address - Street 1:41770 12TH ST W STE C
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1424
Practice Address - Country:US
Practice Address - Phone:661-965-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14321103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist