Provider Demographics
NPI:1114026275
Name:RICHTER, SUSAN LORINDA (MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LORINDA
Last Name:RICHTER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 GRANADA STREET
Mailing Address - Street 2:SUITE N
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010
Mailing Address - Country:US
Mailing Address - Phone:805-987-3162
Mailing Address - Fax:805-383-1502
Practice Address - Street 1:155 GRANADA STREET
Practice Address - Street 2:SUITE N
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-987-3162
Practice Address - Fax:805-383-1502
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist