Diane A. Suffridge, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY10707 Issued in CA

Practice address

555 Northgate Dr
Family Service Agency of Marin
San Rafael, CA 94903-3680

Phone

(415) 491-5708

NPI assigned

Aug 12, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2015 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405468800000",
    "number": "1649282450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 NORTHGATE DR",
            "address_2": "FAMILY SERVICE AGENCY OF MARIN",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949033680",
            "telephone_number": "415-491-5708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 NORTHGATE DR",
            "address_2": "FAMILY SERVICE AGENCY OF MARIN",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949033680",
            "telephone_number": "415-491-5708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUFFRIDGE",
        "first_name": "DIANE",
        "middle_name": "A.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-12",
        "last_updated": "2014-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY10707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melya Stylos
• Vanessa Raquel Su Zhang, PHARMD
• Olivia Simone Suarez-Jew, MD
• Duangmanee Subphasri
• Bonnie H. Sudler, MD
• Diana H. Suh, MD
• David J. Sulciner, MD
• Peter Vaughn Sullivan
• Stayce K Sullivan
• Summit Sober Living Inc.

• Clinical Psychologist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.