Provider Demographics
NPI:1609900091
Name:DUDLEY, SUZANNE VILLAVERDE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:VILLAVERDE
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 SEAL WAY
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6552
Mailing Address - Country:US
Mailing Address - Phone:562-598-1987
Mailing Address - Fax:
Practice Address - Street 1:4565 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-1507
Practice Address - Country:US
Practice Address - Phone:562-422-8472
Practice Address - Fax:562-522-1102
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist