Provider Demographics
NPI:1801952478
Name:GELERMAN, SUSAN SARI (LICENSED CLINICAL SO)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:SARI
Last Name:GELERMAN
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
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Mailing Address - Street 1:3231 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3221
Mailing Address - Country:US
Mailing Address - Phone:310-450-4755
Mailing Address - Fax:310-455-2070
Practice Address - Street 1:3231 OCEAN PARK BLVD #103
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405
Practice Address - Country:US
Practice Address - Phone:310-450-4255
Practice Address - Fax:310-455-2070
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2016-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CALIC6052103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALIC 6052OtherBOARD OF BEHAVIORAL SCIEN