Provider Demographics
NPI:1710030564
Name:PIKE, SUZANNE GRAUPNER (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:GRAUPNER
Last Name:PIKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:GRAUPNER
Other - Last Name:PIKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:975 WOODLAND PKWY APT 155
Mailing Address - Street 2:SUZANNE G. PIKE, PH.D.
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2270
Mailing Address - Country:US
Mailing Address - Phone:619-806-7453
Mailing Address - Fax:
Practice Address - Street 1:400 S MELROSE DR STE 210
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6632
Practice Address - Country:US
Practice Address - Phone:619-806-7453
Practice Address - Fax:760-798-1001
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16492103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 164920OtherMEDICAL
23-2794754OtherTAX ID OTHER THAN SS#
CAPSY 164920OtherMEDICAL