Provider Demographics
NPI:1104009190
Name:SEXTON, SUZANNE M
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:SEXTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15675 AVENIDA ALCACHOFA APT B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4451
Mailing Address - Country:US
Mailing Address - Phone:619-955-2498
Mailing Address - Fax:
Practice Address - Street 1:15675 AVENIDA ALCACHOFA APT B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4451
Practice Address - Country:US
Practice Address - Phone:619-955-2498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT321335-35011041C0700X
FLSW212501041C0700X
CALCSW1229081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical