Provider Demographics
NPI:1629588231
Name:AMENDT, SUZANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:AMENDT
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 1:1836 PIERCE CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-1321
Mailing Address - Country:US
Mailing Address - Phone:925-326-1046
Mailing Address - Fax:
Practice Address - Street 1:43 QUAIL CT STE 213
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8702
Practice Address - Country:US
Practice Address - Phone:925-326-1046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA765661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1041C0700XMedicaid