Provider Demographics
NPI:1760515332
Name:SCHIAVONE, SUSAN L (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:SCHIAVONE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 ORD GROVE AVE.
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955
Mailing Address - Country:US
Mailing Address - Phone:831-277-3009
Mailing Address - Fax:
Practice Address - Street 1:415 FIGUEROA ST.
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-277-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45392106H00000X
CA46479106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist