Provider Demographics
NPI:1962655126
Name:GONZALEZ, SUSETTE AIDETTE (MA MFT)
Entity Type:Individual
Prefix:MS
First Name:SUSETTE
Middle Name:AIDETTE
Last Name:GONZALEZ
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 1:26415 SUMMIT CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2991
Mailing Address - Country:US
Mailing Address - Phone:661-287-1660
Mailing Address - Fax:661-287-1661
Practice Address - Street 1:26415 SUMMIT CIR
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2991
Practice Address - Country:US
Practice Address - Phone:661-287-1660
Practice Address - Fax:661-287-1661
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41130106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist