Provider Demographics
NPI:1932227535
Name:MOCHIZUKI, SUSAN AYAKO ONO
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:AYAKO ONO
Last Name:MOCHIZUKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:A
Other - Last Name:ONO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2325 CLEMENT AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1421
Mailing Address - Country:US
Mailing Address - Phone:510-522-8363
Mailing Address - Fax:510-865-1930
Practice Address - Street 1:2325 CLEMENT AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1421
Practice Address - Country:US
Practice Address - Phone:510-522-8363
Practice Address - Fax:510-865-1930
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical