Provider Demographics
NPI:1215906060
Name:SANFILIPPO, SUSAN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:SANFILIPPO
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 1:10633 GRISSOM AVE
Mailing Address - Street 2:116 MAT
Mailing Address - City:MATHER
Mailing Address - State:CA
Mailing Address - Zip Code:95655-4123
Mailing Address - Country:US
Mailing Address - Phone:916-366-5432
Mailing Address - Fax:916-366-5441
Practice Address - Street 1:10633 GRISSOM AVE
Practice Address - Street 2:116 MAT
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655-4123
Practice Address - Country:US
Practice Address - Phone:916-366-5432
Practice Address - Fax:916-366-5441
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical