Provider Demographics
NPI:1164085098
Name:CLANCE, SUSAN CAROL
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CAROL
Last Name:CLANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:CAROL
Other - Last Name:GYORFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21600 OXNARD ST STE 1800
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:12731 MARBLESTONE DR STE 101
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8334
Practice Address - Country:US
Practice Address - Phone:571-589-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst