Provider Demographics
NPI:1407052541
Name:SCHMIDT-BRACY, SUSANNE JACQUELINE (MFT)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:JACQUELINE
Last Name:SCHMIDT-BRACY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23775 VIA DE GEMA LINDA
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2060
Mailing Address - Country:US
Mailing Address - Phone:951-698-0670
Mailing Address - Fax:
Practice Address - Street 1:23775 VIA DE GEMA LINDA
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-2060
Practice Address - Country:US
Practice Address - Phone:951-698-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33361106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist