Provider Demographics
NPI:1184883845
Name:BEAUDIEU, SUSANNA ALYSON (LCSW)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:ALYSON
Last Name:BEAUDIEU
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 1:3142 VISTA WAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3619
Mailing Address - Country:US
Mailing Address - Phone:760-967-7082
Mailing Address - Fax:760-967-1465
Practice Address - Street 1:3142 VISTA WAY
Practice Address - Street 2:SUITE 207
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3619
Practice Address - Country:US
Practice Address - Phone:760-967-7082
Practice Address - Fax:760-967-1465
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 164531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical