Healthcare Provider Details

I. General information

NPI: 1053384677
Provider Name (Legal Business Name): SUSAN SUGARMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4283 PIEDMONT AVE SUITE E6
OAKLAND CA
94611-4758
US

IV. Provider business mailing address

1200 SUNNYHILLS RD
OAKLAND CA
94610-1818
US

V. Phone/Fax

Practice location:
  • Phone: 510-206-9746
  • Fax:
Mailing address:
  • Phone: 510-206-9746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS18826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: