Provider Demographics
NPI:1811025265
Name:MAUNG, SU SU (MFT)
Entity Type:Individual
Prefix:
First Name:SU SU
Middle Name:
Last Name:MAUNG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:MAUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 8TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607
Mailing Address - Country:US
Mailing Address - Phone:510-869-6092
Mailing Address - Fax:510-268-0202
Practice Address - Street 1:310 8TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6526
Practice Address - Country:US
Practice Address - Phone:510-869-6092
Practice Address - Fax:510-268-0202
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAMFC51546106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist