Provider Demographics
NPI:1063761336
Name:BARSTIS, SUSAN WEISS (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:WEISS
Last Name:BARSTIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N BARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2921
Mailing Address - Country:US
Mailing Address - Phone:310-471-0483
Mailing Address - Fax:310-476-2833
Practice Address - Street 1:150 N BARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-2921
Practice Address - Country:US
Practice Address - Phone:310-471-0483
Practice Address - Fax:310-476-2833
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6217103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical