Provider Demographics
NPI:1851381883
Name:BRACE, SUSAN MARGARET (RN, PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARGARET
Last Name:BRACE
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Gender:F
Credentials:RN, PHD
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Mailing Address - Street 1:1850 SAWTELLE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7084
Mailing Address - Country:US
Mailing Address - Phone:310-477-4420
Mailing Address - Fax:310-829-2814
Practice Address - Street 1:1850 SAWTELLE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7084
Practice Address - Country:US
Practice Address - Phone:310-477-4420
Practice Address - Fax:310-829-2814
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY9227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical