Provider Demographics
NPI:1902567779
Name:HOFFMAN, SUSAN SHAUNA (MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SHAUNA
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24359 WALNUT ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-6101
Mailing Address - Country:US
Mailing Address - Phone:661-714-5137
Mailing Address - Fax:
Practice Address - Street 1:24359 WALNUT ST STE A
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-6101
Practice Address - Country:US
Practice Address - Phone:661-714-5137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35075106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist