Provider Demographics
NPI:1265927685
Name:DALEN, SUSAN SETER (BCBA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:SETER
Last Name:DALEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:SETER
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:2730 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2538
Mailing Address - Country:US
Mailing Address - Phone:510-910-3261
Mailing Address - Fax:
Practice Address - Street 1:2820 SHADELANDS DR STE 200
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2525
Practice Address - Country:US
Practice Address - Phone:510-910-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7579103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst