Provider Demographics
NPI:1003274515
Name:CHOI, SUSAN MYUNGHEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MYUNGHEE
Last Name:CHOI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MYUNGHEE
Other - Middle Name:
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:470 CHADBOURNE RD. SUITE E
Mailing Address - Street 2:ALDEA CHILDREN & FAMILY SERVICES
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9600
Mailing Address - Country:US
Mailing Address - Phone:707-425-9670
Mailing Address - Fax:707-425-9880
Practice Address - Street 1:470 CHADBOURNE RD. SUITE E
Practice Address - Street 2:ALDEA CHILDREN & FAMILY SERVICES
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9600
Practice Address - Country:US
Practice Address - Phone:707-425-9670
Practice Address - Fax:707-425-9880
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW62160101YM0800X
CALCSW81087101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health