Provider Demographics
NPI:1922259084
Name:ALONSO, SUSAN JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:ALONSO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2977 YGNACIO VALLEY RD
Mailing Address - Street 2:#425
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3535
Mailing Address - Country:US
Mailing Address - Phone:925-330-5711
Mailing Address - Fax:
Practice Address - Street 1:432 GRAND OAK CT
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3952
Practice Address - Country:US
Practice Address - Phone:925-330-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA652081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical