Provider Demographics
NPI:1194935908
Name:HANAU, SUSAN D (MFC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:D
Last Name:HANAU
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:D
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1811 SANTA RITA RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4746
Mailing Address - Country:US
Mailing Address - Phone:925-462-9776
Mailing Address - Fax:925-875-9091
Practice Address - Street 1:1811 SANTA RITA RD
Practice Address - Street 2:SUITE 216
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4746
Practice Address - Country:US
Practice Address - Phone:925-462-9776
Practice Address - Fax:925-875-9091
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35293106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist