Provider Demographics
NPI:1134626179
Name:MARGOTTA, SUSAN ELAINE (LMFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:MARGOTTA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22565 HONNOLD DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3605
Mailing Address - Country:US
Mailing Address - Phone:661-644-4166
Mailing Address - Fax:
Practice Address - Street 1:25000 AVENUE STANFORD STE 104
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1224
Practice Address - Country:US
Practice Address - Phone:818-600-2034
Practice Address - Fax:661-667-4477
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT14790106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty