Provider Demographics
NPI:1023375508
Name:SUSA, CARRIE LYNN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:SUSA
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3868 W CARSON ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6711
Mailing Address - Country:US
Mailing Address - Phone:310-792-2877
Mailing Address - Fax:310-792-2878
Practice Address - Street 1:3868 W CARSON ST
Practice Address - Street 2:SUITE #201
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6711
Practice Address - Country:US
Practice Address - Phone:310-792-2877
Practice Address - Fax:310-792-2878
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-7276103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst