Provider Demographics
NPI:1457577280
Name:SHARMA, SUSAN (PSYD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MAPLE CT STE 223
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3567
Mailing Address - Country:US
Mailing Address - Phone:805-628-2546
Mailing Address - Fax:
Practice Address - Street 1:260 MAPLE CT STE 223
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3567
Practice Address - Country:US
Practice Address - Phone:805-628-2546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22787103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical