Provider Demographics
NPI:1992020770
Name:LANDON, SUSAN PAULINE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PAULINE
Last Name:LANDON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 SANTA MONICA BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-3408
Mailing Address - Country:US
Mailing Address - Phone:310-395-9095
Mailing Address - Fax:310-395-3345
Practice Address - Street 1:429 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-3401
Practice Address - Country:US
Practice Address - Phone:310-395-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist