Provider Demographics
NPI:1992877955
Name:ELKIND, SUE N (PHD)
Entity type:Individual
Prefix:DR
First Name:SUE
Middle Name:N
Last Name:ELKIND
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 1:617 IRONBARK CIR
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2423
Mailing Address - Country:US
Mailing Address - Phone:925-254-7411
Mailing Address - Fax:925-254-5824
Practice Address - Street 1:8 ORINDA WAY
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2519
Practice Address - Country:US
Practice Address - Phone:925-254-7411
Practice Address - Fax:925-254-5824
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3351103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000PL33510Medicare ID - Type Unspecified