Provider Demographics
NPI:1932311222
Name:ANDRUK, SUSIE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SUSIE
Middle Name:
Last Name:ANDRUK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:W
Other - Last Name:ANDRUK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2303 FLORENCITA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1817
Mailing Address - Country:US
Mailing Address - Phone:818-219-3006
Mailing Address - Fax:818-957-1749
Practice Address - Street 1:2303 FLORENCITA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1817
Practice Address - Country:US
Practice Address - Phone:818-219-3006
Practice Address - Fax:818-957-1749
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33614106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist