Healthcare Provider Details

I. General information

NPI: 1437286069
Provider Name (Legal Business Name): SUSAN L KOLODNY DMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6239 COLLEGE AVE SUITE 304
OAKLAND CA
94611-2642
US

IV. Provider business mailing address

6239 COLLEGE AVE SUITE 304
OAKLAND CA
94611-2642
US

V. Phone/Fax

Practice location:
  • Phone: 510-339-2877
  • Fax: 510-339-2877
Mailing address:
  • Phone: 510-339-2877
  • Fax: 510-339-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY8555
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPSY8555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: