Provider Demographics
NPI:1497783013
Name:MATTHIESSEN, SUSAN DAYLE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DAYLE
Last Name:MATTHIESSEN
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 1:3209 ESPLANADE STE 150
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0155
Mailing Address - Country:US
Mailing Address - Phone:530-894-2238
Mailing Address - Fax:
Practice Address - Street 1:3209 ESPLANADE STE 150
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0155
Practice Address - Country:US
Practice Address - Phone:530-894-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW179731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical