Provider Demographics
NPI:1740384833
Name:SUCHOV, LINA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINA
Middle Name:B
Last Name:SUCHOV
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 1:16260 VENTURA BLVD STE LL30
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4927
Mailing Address - Country:US
Mailing Address - Phone:818-385-0336
Mailing Address - Fax:818-385-1310
Practice Address - Street 1:16260 VENTURA BLVD STE LL30
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4927
Practice Address - Country:US
Practice Address - Phone:818-385-0336
Practice Address - Fax:818-385-1310
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14451103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA352162103OtherTAX ID NUMBER
CA352162103OtherTAX ID NUMBER