Provider Demographics
NPI:1053420273
Name:RUBINSTEIN, SUSAN MARIE (MFCC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:RUBINSTEIN
Suffix:
Gender:F
Credentials:MFCC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:SUCHOBOKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2701 COTTAGE WAY
Mailing Address - Street 2:#35
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-485-2582
Mailing Address - Fax:916-388-0688
Practice Address - Street 1:2701 COTTAGE WAY
Practice Address - Street 2:#35
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-485-2582
Practice Address - Fax:916-388-0688
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCC9506106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9506OtherMFCC BD BEHAVIORAL SCIENC