Provider Demographics
NPI:1366540965
Name:SCULL, SUDI PLACE (MA)
Entity type:Individual
Prefix:MS
First Name:SUDI
Middle Name:PLACE
Last Name:SCULL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:PLACE
Other - Last Name:SCULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 PERALTA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110
Mailing Address - Country:US
Mailing Address - Phone:415-282-8185
Mailing Address - Fax:
Practice Address - Street 1:2166 HAYES ST
Practice Address - Street 2:# 308
Practice Address - City:SF
Practice Address - State:CA
Practice Address - Zip Code:94117
Practice Address - Country:US
Practice Address - Phone:415-282-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT36910106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist