Healthcare Provider Details

I. General information

NPI: 1932303625
Provider Name (Legal Business Name): SUSAN ENOCHS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 BOREL PL STE 125
SAN MATEO CA
94402-3507
US

IV. Provider business mailing address

3555 S EL CAMINO REAL # 113
SAN MATEO CA
94403-3415
US

V. Phone/Fax

Practice location:
  • Phone: 650-619-7677
  • Fax: 650-577-1014
Mailing address:
  • Phone: 659-619-7677
  • Fax: 650-577-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: