Provider Demographics
NPI:1104987197
Name:MADSON, SUSAN K (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:MADSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HANOVER LN STE B
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7267
Mailing Address - Country:US
Mailing Address - Phone:949-521-9049
Mailing Address - Fax:530-809-4330
Practice Address - Street 1:28 HANOVER LN STE B
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7267
Practice Address - Country:US
Practice Address - Phone:949-521-9049
Practice Address - Fax:530-809-4330
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28954101Y00000X, 251S00000X
CALCS289541041C0700X
CALCSW289541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251S00000XAgenciesCommunity/Behavioral Health