Healthcare Provider Details

I. General information

NPI: 1760549638
Provider Name (Legal Business Name): SUSAN S OWICKI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S CALIFORNIA AVE STE 120
PALO ALTO CA
94306-1636
US

IV. Provider business mailing address

956 N CALIFORNIA AVE
PALO ALTO CA
94303-3405
US

V. Phone/Fax

Practice location:
  • Phone: 650-327-2129
  • Fax:
Mailing address:
  • Phone: 650-327-2129
  • Fax: 650-857-9680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC39238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: