Provider Demographics
NPI:1356701965
Name:DR SUSAN PAZAK PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:DR SUSAN PAZAK PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-363-0700
Mailing Address - Street 1:30131 TOWN CENTER DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2034
Mailing Address - Country:US
Mailing Address - Phone:949-363-0700
Mailing Address - Fax:
Practice Address - Street 1:30131 TOWN CENTER DR
Practice Address - Street 2:SUITE 280
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2034
Practice Address - Country:US
Practice Address - Phone:949-363-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17583251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health