Provider Demographics
NPI:1477979755
Name:MONDELL-COOK, SUZANNE MICHELE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MICHELE
Last Name:MONDELL-COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9562 WINTER GARDENS BLVD # D-320
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-4065
Mailing Address - Country:US
Mailing Address - Phone:619-304-0637
Mailing Address - Fax:619-326-3884
Practice Address - Street 1:4455 MURPHY CANYON RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4379
Practice Address - Country:US
Practice Address - Phone:619-304-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA770601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical