Provider Demographics
NPI:1174814503
Name:MCWAYNE, SUZANNE K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:K
Last Name:MCWAYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29282 RUE CERISE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4305
Mailing Address - Country:US
Mailing Address - Phone:949-363-7720
Mailing Address - Fax:949-794-9494
Practice Address - Street 1:30131 TOWN CENTER DR
Practice Address - Street 2:104
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2034
Practice Address - Country:US
Practice Address - Phone:949-363-7720
Practice Address - Fax:949-794-9494
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 183601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical