Provider Demographics
NPI:1447401054
Name:WILTSEK, SUSAN DANA (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DANA
Last Name:WILTSEK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:344 DOLORES ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1038
Mailing Address - Country:US
Mailing Address - Phone:415-260-3861
Mailing Address - Fax:415-552-0763
Practice Address - Street 1:3708 MT DIABLO BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3631
Practice Address - Country:US
Practice Address - Phone:415-260-2861
Practice Address - Fax:925-299-0519
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20475103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical