SUSAN P. DETRICK (NPI# 1205881885) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205881885 |
| Entity Type | Individual |
| Full Name | SUSAN P. DETRICK |
| Credential | PHD |
| Practice Address |
1555 Parkmoor Ave San Jose CA 95128-2407 |
| Practice Telephone | 4082820402 |
| Mailing Telephone | 4082820402 |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | PSY5071 | CA | Behavioral Health & Social Service Providers |
| Street Address |
1555 PARKMOOR AVE |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95128-2407 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619927340 | Hebe Elisa Estrella-schultz | Psychiatry & Neurology | 1555 Parkmoor Ave, San Jose, CA 95128-2407 | 2006-05-11 |
| 1841803988 | Rob Kim Baum | Counselor | 1555 Parkmoor Ave, San Jose, CA 95128-2407 | 2020-08-28 |
| 1144831413 | Favin Mehari | Counselor | 1555 Parkmoor Ave, San Jose, CA 95128-2407 | 2020-08-11 |
| 1821609314 | Mary Irwin | Physical Therapist | 1555 Parkmoor Ave, San Jose, CA 95128-2407 | 2020-08-10 |
| 1376154872 | Jennifer Fernandez | Counselor | 1555 Parkmoor Ave, San Jose, CA 95128-2407 | 2020-08-10 |
| 1528679024 | Ulises Guarneros | Counselor | 1555 Parkmoor Ave, San Jose, CA 95128-2407 | 2020-08-10 |
| 1023634524 | Annie Tran | Counselor | 1555 Parkmoor Ave, San Jose, CA 95128-2407 | 2020-06-19 |
| 1295354546 | Lisa Weber | Counselor | 1555 Parkmoor Ave, San Jose, CA 95128-2407 | 2020-04-15 |
| 1851910194 | Audrea Bishop | Counselor | 1555 Parkmoor Ave, San Jose, CA 95128-2407 | 2020-04-15 |
| 1013543743 | Karina Goodwin | Counselor | 1555 Parkmoor Ave, San Jose, CA 95128-2407 | 2020-03-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982227138 | Ruth Larsen | Social Worker | 850 S. Bascom Avenue, Suite 280, San Jose, CA 95128 | 2020-05-22 |
| 1265067185 | Of Two Minds Psychotherapy | Marriage & Family Therapist | 190 S. Bascom Ave, Ste 130, San Jose, CA 95128 | 2020-03-11 |
| 1982244166 | Cindy Pantoja Escobar | Behavior Technician | 100 O'connor Drive, Suites 21, San Jose, CA 95128 | 2020-01-15 |
| 1104460591 | Katherine Alexandra Misogas | Pharmacist | 777 Turner Dr # 330, San Jose, CA 95128 | 2019-10-29 |
| 1942842216 | Jodie Pierce | Marriage & Family Therapist | 871 Enborg Lane, San Jose, CA 95128 | 2019-10-08 |
| 1003466434 | Dong Mi Cha | Pharmacist | 777 Turner Dr Ste 330, San Jose, CA 95128 | 2019-09-17 |
| 1114571759 | Sleep Well Acupuncture, Inc | Acupuncturist | 1361 S Winchester Blvd Suite 206, San Jose, CA 95128 | 2019-08-01 |
| 1083277677 | Wellocity, Inc | Health Educator | 334 Santana Row, 318, San Jose, CA 95128 | 2019-04-18 |
| 1518428812 | Alexander Diaz | Radiology | 75 South Bascom Ave, San Jose, CA 95128 | 2019-03-28 |
| 1720542103 | Nanci R Price Inc | Chiropractor | 100 O'connor Dr., Ste 27, San Jose, CA 95128 | 2019-01-30 |
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| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548896236 | Gregory P. Salerno, Ph.d., A Psychology Corporation | Psychologist | 390 Spar Ave Ste 205, San Jose, CA 95117-1644 | 2020-03-13 |
| 1548766454 | Jenifer Miri | Psychologist | 6370 Mojave Dr, San Jose, CA 95120-5310 | 2018-04-01 |
| 1417460676 | Belinda Sangrat | Psychologist | 275 Hospital Pkwy Ste 370, San Jose, CA 95119-1136 | 2017-11-09 |
| 1659818060 | Kathlyn Clementelli | Psychologist | 3212 Tenley Dr, San Jose, CA 95148-3639 | 2017-01-23 |
| 1932650223 | Lorena Ho | Psychologist | 199 Laurel Grove Ln, San Jose, CA 95126-4848 | 2016-10-20 |
| 1477906410 | Momentum for Mental Health - Crisis Stabilization | Psychologist | 101 Jose Figueres Ave Ste 50, San Jose, CA 95116-2022 | 2016-07-14 |
| 1215388764 | Momentum for Mental Health - Cr | Psychologist | 101 Jose Figueres Ave Ste 10, San Jose, CA 95116-2022 | 2016-06-27 |
| 1306214325 | Amanda Montgomery | Psychologist | 4300 Stevens Creek Blvd Ste 260, San Jose, CA 95129 | 2015-09-08 |
| 1386046258 | Nicole Dow | Psychologist | 1417 Allegado Aly, San Jose, CA 95128-4547 | 2014-09-22 |
| 1902219850 | Rohn Taylor Stark Jr. | Psychologist | 150 Palm Valley Blvd, 3128, San Jose, CA 95123-1060 | 2014-06-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.