Provider Demographics
NPI:1942363122
Name:SLOMAN, SUZANNE GAYNOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:GAYNOR
Last Name:SLOMAN
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 1:559 COLUSA AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1530
Mailing Address - Country:US
Mailing Address - Phone:510-881-2026
Mailing Address - Fax:510-690-1344
Practice Address - Street 1:20081 LAKE CHABOT BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546
Practice Address - Country:US
Practice Address - Phone:510-881-2026
Practice Address - Fax:510-690-1344
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5422103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000PL5422Medicare ID - Type Unspecified