Provider Demographics
NPI:1649464330
Name:MARROQUIN, SUSANA MARGOTH
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:MARGOTH
Last Name:MARROQUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 N BELLFLOWER BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4020
Mailing Address - Country:US
Mailing Address - Phone:562-668-0186
Mailing Address - Fax:
Practice Address - Street 1:1777 N BELLFLOWER BLVD STE 206
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4020
Practice Address - Country:US
Practice Address - Phone:562-668-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA105624106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health