Provider Demographics
NPI:1245399047
Name:SERUBY, SUSAN A (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:SERUBY
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 1:4785 N 1ST ST FL 2
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0513
Mailing Address - Country:US
Mailing Address - Phone:559-448-4939
Mailing Address - Fax:
Practice Address - Street 1:4785 N 1ST ST FL 2
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0513
Practice Address - Country:US
Practice Address - Phone:559-448-4939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health