Provider Demographics
NPI:1780820415
Name:MATHEWS, SUZANNE (PHD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MATHEWS
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:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-0472
Mailing Address - Country:US
Mailing Address - Phone:858-350-9821
Mailing Address - Fax:
Practice Address - Street 1:7946 IVANHOE AVE STE 211
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4517
Practice Address - Country:US
Practice Address - Phone:858-353-1631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29473103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical