Provider Demographics
NPI:1013048313
Name:SORENSEN, SUE NOVACK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:NOVACK
Last Name:SORENSEN
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 1:1852 MARY RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510-1493
Mailing Address - Country:US
Mailing Address - Phone:661-269-2290
Mailing Address - Fax:661-269-2213
Practice Address - Street 1:12450 VAN NUYS BLVD
Practice Address - Street 2:100
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1391
Practice Address - Country:US
Practice Address - Phone:818-896-8366
Practice Address - Fax:818-896-8392
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 137091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical