Provider Demographics
NPI:1144313040
Name:BERTOZZI, SUSAN (MFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BERTOZZI
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 1:2535 FOREST AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7691
Mailing Address - Country:US
Mailing Address - Phone:530-518-7231
Mailing Address - Fax:530-809-2437
Practice Address - Street 1:2535 FOREST AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7691
Practice Address - Country:US
Practice Address - Phone:530-518-7231
Practice Address - Fax:530-809-2437
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT44735106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty