Provider Demographics
NPI:1013133099
Name:WALDMAN, SUSAN D (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:D
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SOTELO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1424
Mailing Address - Country:US
Mailing Address - Phone:415-346-2823
Mailing Address - Fax:
Practice Address - Street 1:1947 DIVISADERO ST STE 1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2532
Practice Address - Country:US
Practice Address - Phone:415-346-3823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17985103T00000X, 103TC0700X
CAMFT 15706106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist