Healthcare Provider Details

I. General information

NPI: 1679489009
Provider Name (Legal Business Name): SUSAN ABRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17797 RIDGEWAY RD
GRANADA HILLS CA
91344-2132
US

IV. Provider business mailing address

17797 RIDGEWAY RD
GRANADA HILLS CA
91344-2132
US

V. Phone/Fax

Practice location:
  • Phone: 818-425-3685
  • Fax:
Mailing address:
  • Phone: 818-425-3685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number230091980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: