Active NPI
Susan Glick, PHD
- Clinical Psychologist
- San Rafael, CA
National Provider Identifier
1649063470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY18514
- Practice address
- 1703 5TH Ave Ste 304
San Rafael, CA 94901-1854 - Phone
- (510) 381-2984
- NPI assigned
- May 24, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY18514 | CA | Primary |
Addresses
Primary practice location
1703 5TH Ave Ste 304
San Rafael, CA 94901-1854
Mailing address
41 Bungalow Ave
San Rafael, CA 94901-5140
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY18514 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748044800000",
"number": "1649063470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 BUNGALOW AVE",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949015140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1703 5TH AVE STE 304",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949011854",
"telephone_number": "510-381-2984"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLICK",
"first_name": "SUSAN",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-05-24",
"last_updated": "2025-05-24",
"certification_date": "2025-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18514",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.