Provider Demographics
NPI:1770739823
Name:MENKES, SUSAN G (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:MENKES
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 1:4974 PALO DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4441
Mailing Address - Country:US
Mailing Address - Phone:818-705-8644
Mailing Address - Fax:818-705-6244
Practice Address - Street 1:4974 PALO DR
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4441
Practice Address - Country:US
Practice Address - Phone:818-705-8644
Practice Address - Fax:818-705-6244
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 7924302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization