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General NPI Number Information
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NPI Number | 1518197094
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Entity Type | Individual
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Provider Name | SUSANNE BARNES MCGAVIN M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 3440 AIRWAY DR SUITE E
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City | SANTA ROSA
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State | CA
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Zip | 95403-2065
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Country | US
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Telephone | 707-544-3299
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Fax | 707-544-6837
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | PETALUMA
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State | CA
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Zip | 94953-0007
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Country | US
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Telephone | 415-846-2926
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC39738
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License Number State | CA
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