Provider Demographics
NPI:1801099577
Name:JOSEPHSON, SUSAN PHYLLIS (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PHYLLIS
Last Name:JOSEPHSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 S PALM DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3512
Mailing Address - Country:US
Mailing Address - Phone:310-477-7171
Mailing Address - Fax:
Practice Address - Street 1:11645 WILSHIRE BLVD
Practice Address - Street 2:SUITE 702
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1708
Practice Address - Country:US
Practice Address - Phone:310-477-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG432142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry