Provider Demographics
NPI:1942824875
Name:GORNEY, BETH SUZANNE (PHD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:SUZANNE
Last Name:GORNEY
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 1:2406 READ AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1516
Mailing Address - Country:US
Mailing Address - Phone:650-323-7011
Mailing Address - Fax:
Practice Address - Street 1:2406 READ AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-1516
Practice Address - Country:US
Practice Address - Phone:650-323-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-06
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10103103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist