Provider Demographics
NPI:1487728598
Name:DILLMANN, SUSANNE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:M
Last Name:DILLMANN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S JUNIPER ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4229
Mailing Address - Country:US
Mailing Address - Phone:760-743-7789
Mailing Address - Fax:
Practice Address - Street 1:210 S JUNIPER ST
Practice Address - Street 2:SUITE 213
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4229
Practice Address - Country:US
Practice Address - Phone:760-743-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAPSY21969103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health