Provider Demographics
NPI:1407243322
Name:BEDROSIAN, SUSAN DUQUE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DUQUE
Last Name:BEDROSIAN
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 1:32481 DEL ZURA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-7103
Mailing Address - Country:US
Mailing Address - Phone:949-310-5253
Mailing Address - Fax:949-606-0304
Practice Address - Street 1:32481 DEL ZURA
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-7103
Practice Address - Country:US
Practice Address - Phone:949-310-5253
Practice Address - Fax:949-606-0304
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 171581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical