Provider Demographics
NPI:1659791234
Name:VANALLEN, SUSAN Y (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:Y
Last Name:VANALLEN
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 1:43322 GINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-4576
Mailing Address - Country:US
Mailing Address - Phone:661-874-4050
Mailing Address - Fax:
Practice Address - Street 1:43322 GINGHAM AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4576
Practice Address - Country:US
Practice Address - Phone:661-874-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health