Provider Demographics
NPI:1669683249
Name:QUINTERO, SUSANNA M (LCSW 96446)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:M
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:LCSW 96446
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:M
Other - Last Name:QUINTERO-RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW 96446
Mailing Address - Street 1:1950 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1222
Mailing Address - Country:US
Mailing Address - Phone:650-573-3587
Mailing Address - Fax:650-572-9347
Practice Address - Street 1:1950 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1222
Practice Address - Country:US
Practice Address - Phone:650-573-3587
Practice Address - Fax:650-572-9347
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW964461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical