Healthcare Provider Details

I. General information

NPI: 1396946802
Provider Name (Legal Business Name): SUSAN I. KOBRIN MA, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: UNA S. KOBRIN SAME AS ABOVE

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12920 SLATE CREEK RD
NEVADA CITY CA
95959-8215
US

IV. Provider business mailing address

12920 SLATE CREEK RD
NEVADA CITY CA
95959-8215
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-2481
  • Fax:
Mailing address:
  • Phone: 530-273-2481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT#36632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: