Provider Demographics
NPI:1679924179
Name:MERLETTI, SUSAN MARIA (LPCC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIA
Last Name:MERLETTI
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E MONTECITO AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1937
Mailing Address - Country:US
Mailing Address - Phone:626-623-3111
Mailing Address - Fax:
Practice Address - Street 1:160 E MONTECITO AVE
Practice Address - Street 2:SUITE G
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-1937
Practice Address - Country:US
Practice Address - Phone:626-623-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-26
Last Update Date:2016-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC1253101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional