Basic Information
| Provider Information | |||||||||
| NPI: | 1992052138 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAES | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | PRIOR | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PRIOR | ||||||||
| OtherFirstName: | SUSAN | ||||||||
| OtherMiddleName: | NEWMAN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 22505 WOODROE AVE | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945413410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103186112 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1430 WILLOW PASS RD | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945207928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252883912 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2012 | ||||||||
| LastUpdateDate: | 08/20/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 64238 | CA | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | ASW64238 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | 99275 | CA | N | Behavioral Health & Social Service Providers | Social Worker | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 1041C0700X | 99275 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.