Healthcare Provider Details

I. General information

NPI: 1447389945
Provider Name (Legal Business Name): SUSAN SEKLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 E 12TH ST STE 259
OAKLAND CA
94601-2940
US

IV. Provider business mailing address

1429 HAWTHORNE TER
BERKELEY CA
94708-1803
US

V. Phone/Fax

Practice location:
  • Phone: 510-269-9030
  • Fax: 510-269-9031
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: