MEDICARE: SUSAN ZORN PH D

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	103T00000X	Psychologist	760	NM

General Provider Information

NPI Number	:	1992790208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ZORN PH D

Provider Business Mailing Address
First Line	:	1390 CAMINO SIN SALIDA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-6311
Country	:	US
Telephone Number	:	505-982-1241
Fax Number	:

Provider Business Practice Location Address
First Line	:	1448 S SAINT FRANCIS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4038
Country	:	US
Telephone Number	:	505-982-1241
Fax Number	:

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	06/30/2008

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Directions to “ SUSAN ZORN PH D” Practice Location

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