MEDICARE: SUZANNE COKENIAS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY14527	CA

General Provider Information

NPI Number	:	1184737215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE COKENIAS PHD

Provider Business Mailing Address
First Line	:	1 BAYWOOD AVENUE STE. 7
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94402-1537
Country	:	US
Telephone Number	:	650-344-6961
Fax Number	:

Provider Business Practice Location Address
First Line	:	851 FREMONT AVE
Second Line	:	SUITE 214
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-5698
Country	:	US
Telephone Number	:	650-726-7197
Fax Number	:	650-726-1252

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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Directions to “ SUZANNE COKENIAS PHD” Practice Location

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