Provider Demographics
NPI:1275806333
Name:WATKINS, SUSAN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:J
Other - Last Name:ROBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:29970 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2645
Mailing Address - Country:US
Mailing Address - Phone:951-941-2020
Mailing Address - Fax:
Practice Address - Street 1:29970 TECHNOLOGY DR
Practice Address - Street 2:SUITE 207
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2645
Practice Address - Country:US
Practice Address - Phone:951-941-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50315106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist