Provider Demographics
NPI:1366011710
Name:TATE, SUSANNAH CLAIRE (MSWI)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:CLAIRE
Last Name:TATE
Suffix:
Gender:F
Credentials:MSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 CASSIDY ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-5316
Mailing Address - Country:US
Mailing Address - Phone:760-439-4577
Mailing Address - Fax:
Practice Address - Street 1:408 CASSIDY ST STE 103
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5316
Practice Address - Country:US
Practice Address - Phone:760-439-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X, 1041C0700X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program