Provider Demographics
NPI:1891817532
Name:BUCHHOLZ, SUSAN W (PHD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:W
Last Name:BUCHHOLZ
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 1:1174 CASTRO ST STE 275
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2571
Mailing Address - Country:US
Mailing Address - Phone:650-988-8011
Mailing Address - Fax:650-988-8012
Practice Address - Street 1:1174 CASTRO ST STE 275
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2571
Practice Address - Country:US
Practice Address - Phone:650-988-8011
Practice Address - Fax:650-988-8012
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10561103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY10561OtherLICENSE
CAPSY10561OtherLICENSE