Provider Demographics
NPI:1770960221
Name:DAHDUL, SUSANA (LCSW)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:DAHDUL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1510 SAN PABLO ST
Mailing Address - Street 2:HCC 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5320
Mailing Address - Country:US
Mailing Address - Phone:323-442-9627
Mailing Address - Fax:323-442-8685
Practice Address - Street 1:1510 SAN PABLO ST
Practice Address - Street 2:HCC 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5320
Practice Address - Country:US
Practice Address - Phone:323-442-9627
Practice Address - Fax:323-442-8685
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW619471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW61947Other1041C0700X