Provider Demographics
NPI:1457782484
Name:COLE, SUSAN SAVELLA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:SAVELLA
Last Name:COLE
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 1:15633 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-9998
Mailing Address - Country:US
Mailing Address - Phone:760-881-0564
Mailing Address - Fax:760-259-2003
Practice Address - Street 1:15633 11TH STREET
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-9998
Practice Address - Country:US
Practice Address - Phone:760-881-0564
Practice Address - Fax:760-259-2003
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical