Provider Demographics
NPI:1346899838
Name:DE SANZ, SUZANNA (LMFT)
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:
Last Name:DE SANZ
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 1:810 COLLEGE AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2565
Mailing Address - Country:US
Mailing Address - Phone:415-870-3347
Mailing Address - Fax:
Practice Address - Street 1:810 COLLEGE AVE STE 1C
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-2565
Practice Address - Country:US
Practice Address - Phone:415-870-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT123934106H00000X, 106H00000X
CAAMFT111775101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health