Healthcare Provider Details

I. General information

NPI: 1376127761
Provider Name (Legal Business Name): SUSAN P NIELSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 LA COLINA RD
SANTA BARBARA CA
93110-1563
US

IV. Provider business mailing address

3970 LA COLINA RD
SANTA BARBARA CA
93110-1563
US

V. Phone/Fax

Practice location:
  • Phone: 805-896-6318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: