Provider Demographics
NPI:1295180446
Name:ROME, SUSIE COLE (MASTER OF ART LMFT)
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:COLE
Last Name:ROME
Suffix:
Gender:F
Credentials:MASTER OF ART LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24933 KIT CARSON RD
Mailing Address - Street 2:
Mailing Address - City:HIDDEN HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1136
Mailing Address - Country:US
Mailing Address - Phone:818-704-0084
Mailing Address - Fax:
Practice Address - Street 1:23480 PARK SORRENTO
Practice Address - Street 2:SUITE 209A
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1306
Practice Address - Country:US
Practice Address - Phone:818-704-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 24106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT 24106OtherLICENSED MARRIAGE AND FAMILY THERAPIST
CAMR24106OtherLMFT