Provider Demographics
NPI:1699192542
Name:SHEPHERD, SUSAN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:SHEPHERD
Other - Last Name:GUARNOTTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:200 W. ARBOR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-0989
Mailing Address - Country:US
Mailing Address - Phone:619-543-6222
Mailing Address - Fax:
Practice Address - Street 1:8950 VILLA LA JOLLA DR
Practice Address - Street 2:SUITE C-207
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1714
Practice Address - Country:US
Practice Address - Phone:858-534-8730
Practice Address - Fax:858-534-8863
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 105641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical