Provider Demographics
NPI:1134271430
Name:RICHARDSON, SUSAN L (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:AARESTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:301 E BETHANY HOME RD STE C296
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1271
Mailing Address - Country:US
Mailing Address - Phone:623-910-1432
Mailing Address - Fax:
Practice Address - Street 1:301 E BETHANY HOME RD STE C296
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1271
Practice Address - Country:US
Practice Address - Phone:623-910-1432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1093103T00000X
AZ3541103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0617430OtherBCBS OF AZ
AZAZ0617430OtherBCBS OF AZ