Provider Demographics
NPI:1235348764
Name:ALDIMASSI, SUZAN AHMAD (MS, MFT)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:AHMAD
Last Name:ALDIMASSI
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2220
Mailing Address - Country:US
Mailing Address - Phone:949-235-7606
Mailing Address - Fax:
Practice Address - Street 1:1000 QUAIL ST STE 175
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2766
Practice Address - Country:US
Practice Address - Phone:949-235-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional