Provider Demographics
NPI:1467560367
Name:TITUS, SUSAN (CNS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:TITUS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:TITUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNS
Mailing Address - Street 1:P O BOX HH
Mailing Address - Street 2:BUSINESS DEVELOPMENT & CONTRACTING
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942
Mailing Address - Country:US
Mailing Address - Phone:831-622-2716
Mailing Address - Fax:831-625-4764
Practice Address - Street 1:23625 HOLMAN HWY
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5902
Practice Address - Country:US
Practice Address - Phone:831-624-5311
Practice Address - Fax:831-625-4948
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN336344364SP0808X, 364SP0809X, 364SP0811X, 364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Not Answered364SP0811XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Chronically Ill
Not Answered364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Geropsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24198ZMedicare ID - Type Unspecified
CAP67989Medicare UPIN