Provider Demographics
NPI:1881867422
Name:TAVIANSKY, SUZANNE KIM
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KIM
Last Name:TAVIANSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 BRYANT STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1612
Mailing Address - Country:US
Mailing Address - Phone:415-538-5500
Mailing Address - Fax:
Practice Address - Street 1:679 BRYANT STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1612
Practice Address - Country:US
Practice Address - Phone:415-538-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)