Provider Demographics
NPI:1841432382
Name:TRINQUE MAGANA, SUSETTE (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSETTE
Middle Name:
Last Name:TRINQUE MAGANA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:SUSETTE
Other - Middle Name:
Other - Last Name:TRINQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4510 E PACIFIC COAST HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-6928
Mailing Address - Country:US
Mailing Address - Phone:562-888-1368
Mailing Address - Fax:
Practice Address - Street 1:4510 E PACIFIC COAST HWY STE 210
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-6928
Practice Address - Country:US
Practice Address - Phone:562-888-1368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC #52757106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist