1790829190 NPI number — MS. SUSAN ELIZABETH LENNEN MFT

Table of content: MS. SUSAN ELIZABETH LENNEN MFT (NPI 1790829190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790829190 NPI number — MS. SUSAN ELIZABETH LENNEN MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENNEN
Provider First Name:
SUSAN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790829190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5198 EDGEWORTH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92109-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-208-1575
Provider Business Mailing Address Fax Number:
619-677-3984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-208-1575
Provider Business Practice Location Address Fax Number:
619-677-3984
Provider Enumeration Date:
02/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC18989 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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