Provider Demographics
NPI:1659448728
Name:BALCARCEL, SUSAN SWEIGARD (RN, MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SWEIGARD
Last Name:BALCARCEL
Suffix:
Gender:F
Credentials:RN, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 MONO WAY
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5163
Mailing Address - Country:US
Mailing Address - Phone:209-588-9528
Mailing Address - Fax:
Practice Address - Street 1:197 MONO WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5163
Practice Address - Country:US
Practice Address - Phone:209-588-9528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32811106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist