Provider Demographics
NPI:1528082765
Name:CAREY, SUSAN PATRICIA (MFTI)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PATRICIA
Last Name:CAREY
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 LEGION ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2426
Mailing Address - Country:US
Mailing Address - Phone:949-715-1050
Mailing Address - Fax:
Practice Address - Street 1:2183 FAIRVIEW RD
Practice Address - Street 2:100
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5663
Practice Address - Country:US
Practice Address - Phone:949-515-5440
Practice Address - Fax:949-515-5444
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 38841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YMO800XOtherCOUNSELOR