Provider Demographics
NPI:1366897159
Name:WORD, SUSAN (PMHNP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:WORD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 EDWARDS CT STE 103
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-2421
Mailing Address - Country:US
Mailing Address - Phone:650-342-1966
Mailing Address - Fax:650-685-6552
Practice Address - Street 1:25 EDWARDS CT STE 103
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-2421
Practice Address - Country:US
Practice Address - Phone:415-990-0913
Practice Address - Fax:775-982-7800
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95023848363LP0808X
CA384589163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse