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Individual
DR. SUSAN MARIE WILDE
Active
Individual
DR. SUSAN MARIE WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
PSY19673
CA
103TB0200X
Cognitive & Behavioral Psychologist
PSY19673
CA
103TC0700X
Clinical Psychologist
Primary
PSY19673
CA
Other
Enumeration date
11/13/2008
Last updated
11/13/2008
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