Provider Demographics
NPI:1104254770
Name:CORWIN, SUZANNE MARY (LEP)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MARY
Last Name:CORWIN
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:MARY
Other - Last Name:RATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LEP
Mailing Address - Street 1:31666 FOXFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4714
Mailing Address - Country:US
Mailing Address - Phone:818-889-8661
Mailing Address - Fax:
Practice Address - Street 1:31666 FOXFIELD DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4714
Practice Address - Country:US
Practice Address - Phone:818-889-8661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEX1639103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7577933453Medicare PIN