Provider Demographics
NPI:1790829190
Name:LENNEN, SUSAN ELIZABETH (MFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:LENNEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5198 EDGEWORTH RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1429
Mailing Address - Country:US
Mailing Address - Phone:619-208-1575
Mailing Address - Fax:619-677-3984
Practice Address - Street 1:2727 CAMINO DEL RIO S
Practice Address - Street 2:STE 150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3750
Practice Address - Country:US
Practice Address - Phone:619-208-1575
Practice Address - Fax:619-677-3984
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC18989106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist