Provider Demographics
NPI:1376700948
Name:CHALLEN, SUSAN B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:B
Last Name:CHALLEN
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 1:1423 FARRAGUT CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6371
Mailing Address - Country:US
Mailing Address - Phone:530-297-7668
Mailing Address - Fax:
Practice Address - Street 1:1423 FARRAGUT CIR
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6371
Practice Address - Country:US
Practice Address - Phone:530-297-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA059991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical