Provider Demographics
NPI:1477795151
Name:WINGFIELD-RITTER, SUSAN (MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WINGFIELD-RITTER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:WINGFIELD RITTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:3990 OLD TOWN AVE
Mailing Address - Street 2:SUITE A-207
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2930
Mailing Address - Country:US
Mailing Address - Phone:858-581-1852
Mailing Address - Fax:858-581-1852
Practice Address - Street 1:3990 OLD TOWN AVE
Practice Address - Street 2:SUITE A-207
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2930
Practice Address - Country:US
Practice Address - Phone:858-581-1852
Practice Address - Fax:858-581-1852
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34658106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist