Provider Demographics
NPI:1790165223
Name:CARTER, SUSAN BROOKS (LAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BROOKS
Last Name:CARTER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1321
Mailing Address - Country:US
Mailing Address - Phone:510-359-7080
Mailing Address - Fax:
Practice Address - Street 1:3380 20TH ST STE 102
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-255-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265636171100000X
CAAC 16189171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist