Provider Demographics
NPI:1982126314
Name:COMELO, SUZANNE FISCHER
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:FISCHER
Last Name:COMELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25518 CONLEY DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5497
Mailing Address - Country:US
Mailing Address - Phone:415-412-1458
Mailing Address - Fax:
Practice Address - Street 1:510 16TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1520
Practice Address - Country:US
Practice Address - Phone:510-357-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist