Provider Demographics
NPI:1235504275
Name:SUGERMAN, DORIS (L CSW)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:SUGERMAN
Suffix:
Gender:F
Credentials:L CSW
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6771 TIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-1638
Mailing Address - Country:US
Mailing Address - Phone:971-801-5072
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-2081
Practice Address - Country:US
Practice Address - Phone:619-532-5761
Practice Address - Fax:619-532-8353
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
AZLMSW-173061041C0700X
AZLCSW-197931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker