Provider Demographics
NPI:1104092279
Name:ROSS, SUSAN LEVITAS (MFT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LEVITAS
Last Name:ROSS
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 1:33 QUAIL CT
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5596
Mailing Address - Country:US
Mailing Address - Phone:925-253-1185
Mailing Address - Fax:
Practice Address - Street 1:33 QUAIL CT
Practice Address - Street 2:SUITE 300
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5596
Practice Address - Country:US
Practice Address - Phone:925-253-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC14257106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist