Provider Demographics
NPI:1760575492
Name:MALDE, SUSAN RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RUTH
Last Name:MALDE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1187 COAST VILLAGE ROAD
Mailing Address - Street 2:SUITE 10K
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2737
Mailing Address - Country:US
Mailing Address - Phone:805-969-9103
Mailing Address - Fax:805-969-9103
Practice Address - Street 1:1187 COAST VILLAGE ROAD
Practice Address - Street 2:SUITE 10K
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-2737
Practice Address - Country:US
Practice Address - Phone:805-969-9103
Practice Address - Fax:805-969-9103
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9125103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical