Provider Demographics
NPI:1821345034
Name:GARDIN, SUSAN (DRPH, LMHC, LPCC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:GARDIN
Suffix:
Gender:F
Credentials:DRPH, LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2279 WEYBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1343
Mailing Address - Country:US
Mailing Address - Phone:347-907-1961
Mailing Address - Fax:
Practice Address - Street 1:2279 WEYBRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-1343
Practice Address - Country:US
Practice Address - Phone:347-907-1961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY006234101YM0800X
CALPCC-4062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health