Provider Demographics
NPI:1235728692
Name:LOFGREN, SUSAN (LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LOFGREN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 KINGSWELL AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-4301
Mailing Address - Country:US
Mailing Address - Phone:323-243-9044
Mailing Address - Fax:
Practice Address - Street 1:107 S FAIR OAKS AVE STE 327
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2086
Practice Address - Country:US
Practice Address - Phone:323-243-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121970106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist