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General NPI Number Information
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NPI Number | 1326413063
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Entity Type | Individual
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Provider Name | SUSAN MARIE OVERHAUSER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 02/03/2019
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Provider Practice Location Address
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Address Line | 3468 MT DIABLO BLVD STE B203
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City | LAFAYETTE
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State | CA
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Zip | 94549-7120
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Country | US
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Telephone | 925-386-6062
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Fax | 510-222-2090
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Provider Business Mailing Address
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Address Line | 3468 MT DIABLO BLVD STE B203
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City | LAFAYETTE
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State | CA
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Zip | 94549-7120
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Country | US
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Telephone | 925-386-6062
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Fax | 510-222-2090
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 29951
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 29951
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License Number State | CA
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