Basic Information
| Provider Information | |||||||||
| NPI: | 1164462883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'BRIEN | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2125 S EL CAMINO REAL | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920546260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608770175 | ||||||||
| FaxNumber: | 7609676042 | ||||||||
| Practice Location | |||||||||
| Address1: | 2125 S EL CAMINO REAL | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920546260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608770175 | ||||||||
| FaxNumber: | 7609676042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 11/24/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY20502 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.