Provider Demographics
NPI:1396946802
Name:KOBRIN, SUSAN I (MA, MFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:I
Last Name:KOBRIN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:UNA
Other - Middle Name:S
Other - Last Name:KOBRIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SAME AS ABOVE
Mailing Address - Street 1:12920 SLATE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-8215
Mailing Address - Country:US
Mailing Address - Phone:530-273-2481
Mailing Address - Fax:
Practice Address - Street 1:12920 SLATE CREEK RD
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-8215
Practice Address - Country:US
Practice Address - Phone:530-273-2481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT#36632106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist