Provider Demographics
NPI:1659641348
Name:PARMELEE, SUSAN RS (LCSW757679)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RS
Last Name:PARMELEE
Suffix:
Gender:F
Credentials:LCSW757679
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:STIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:300 CORTE MIRA VIS
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6904
Mailing Address - Country:US
Mailing Address - Phone:949-680-0516
Mailing Address - Fax:
Practice Address - Street 1:700 AVENIDA PICO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-5681
Practice Address - Country:US
Practice Address - Phone:949-680-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW757691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical