Provider Demographics
NPI:1851512131
Name:MANN, SUZANNE BETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:BETTE
Last Name:MANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:LANDRES
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3205 SONOMA ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:310-320-9307
Mailing Address - Fax:310-320-9307
Practice Address - Street 1:23545 CRENSHAW BLVD
Practice Address - Street 2:#101B
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-320-9307
Practice Address - Fax:310-320-9307
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12091103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY120910Medicare UPIN
CAPSY12091Medicare ID - Type Unspecified