Healthcare Provider Details

I. General information

NPI: 1326523044
Provider Name (Legal Business Name): SUSAN RYAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 UNIVERSITY AVE STE 2B
BERKELEY CA
94704-3264
US

IV. Provider business mailing address

2020 MILVIA ST STE 450
BERKELEY CA
94704-1297
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-9716
  • Fax:
Mailing address:
  • Phone: 510-214-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: