Provider Demographics
NPI:1215142823
Name:BORKIN, SUSAN
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:BORKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BORKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:19925 STEVENS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2300
Mailing Address - Country:US
Mailing Address - Phone:408-973-7877
Mailing Address - Fax:
Practice Address - Street 1:19925 STEVENS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2300
Practice Address - Country:US
Practice Address - Phone:408-973-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC16756106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist