Provider Demographics
NPI:1821013475
Name:RAEBURN, SUSAN DELANEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DELANEY
Last Name:RAEBURN
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 1:2576 SHATTUCK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2724
Mailing Address - Country:US
Mailing Address - Phone:510-841-1820
Mailing Address - Fax:
Practice Address - Street 1:2576 SHATTUCK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2724
Practice Address - Country:US
Practice Address - Phone:510-841-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9891103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical