Provider Demographics
NPI:1225728421
Name:BRUMER, SUSAN BONNIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:BONNIE
Last Name:BRUMER
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 1:4237 VIA MARINA # J105
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5493
Mailing Address - Country:US
Mailing Address - Phone:310-508-8493
Mailing Address - Fax:
Practice Address - Street 1:4237 VIA MARINA APT 105
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-4551
Practice Address - Country:US
Practice Address - Phone:310-508-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW100591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical