Healthcare Provider Details

I. General information

NPI: 1215606553
Provider Name (Legal Business Name): SUZANNE BUKINIK MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 WILSHIRE BLVD STE 400
BEVERLY HILLS CA
90211-2400
US

IV. Provider business mailing address

8383 WILSHIRE BLVD STE 400
BEVERLY HILLS CA
90211-2400
US

V. Phone/Fax

Practice location:
  • Phone: 424-281-0087
  • Fax:
Mailing address:
  • Phone: 310-271-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number96040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: