Healthcare Provider Details

I. General information

NPI: 1457577280
Provider Name (Legal Business Name): SUSAN SHARMA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 E MAIN ST STE 201
VENTURA CA
93003-2619
US

IV. Provider business mailing address

2590 E MAIN ST STE 201
VENTURA CA
93003-2619
US

V. Phone/Fax

Practice location:
  • Phone: 805-628-2546
  • Fax:
Mailing address:
  • Phone: 805-628-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 22787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: