Provider Demographics
NPI:1861682924
Name:GRANATA, SUSAN MICHELE (MA, MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MICHELE
Last Name:GRANATA
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 ARDEN DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4501
Mailing Address - Country:US
Mailing Address - Phone:760-230-2397
Mailing Address - Fax:
Practice Address - Street 1:533 2ND ST
Practice Address - Street 2:SUITE C
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3505
Practice Address - Country:US
Practice Address - Phone:760-230-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43805106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist