Provider Demographics
NPI:1437267697
Name:GITTLEMAN-DAVIES, SUSAN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:GITTLEMAN-DAVIES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24050 MADISON ST
Mailing Address - Street 2:100-N
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24050 MADISON ST
Practice Address - Street 2:100-N
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6015
Practice Address - Country:US
Practice Address - Phone:310-803-5441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9757Medicare ID - Type Unspecified