Provider Demographics
NPI:1578764064
Name:LENNOX, SUZANN NMN (MA, MFT)
Entity Type:Individual
Prefix:
First Name:SUZANN
Middle Name:NMN
Last Name:LENNOX
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 RUBENSTEIN AVE
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-2401
Mailing Address - Country:US
Mailing Address - Phone:858-481-6300
Mailing Address - Fax:
Practice Address - Street 1:1519 RUBENSTEIN AVE
Practice Address - Street 2:
Practice Address - City:CARDIFF BY THE SEA
Practice Address - State:CA
Practice Address - Zip Code:92007-2401
Practice Address - Country:US
Practice Address - Phone:858-481-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist