Healthcare Provider Details

I. General information

NPI: 1508154899
Provider Name (Legal Business Name): SUE VONBAEYER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 PARK HILLS RD
BERKELEY CA
94708-1746
US

IV. Provider business mailing address

1169 PARK HILLS RD
BERKELEY CA
94708-1746
US

V. Phone/Fax

Practice location:
  • Phone: 510-849-4403
  • Fax:
Mailing address:
  • Phone: 510-849-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberPSY11893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: