Provider Demographics
NPI:1154170736
Name:SULARO LICENSED CLINICAL SOCIAL WORKER INC
Entity type:Organization
Organization Name:SULARO LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-991-1804
Mailing Address - Street 1:908 S VILLAGE OAKS DR STE 8
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3682
Mailing Address - Country:US
Mailing Address - Phone:626-991-1804
Mailing Address - Fax:
Practice Address - Street 1:908 S VILLAGE OAKS DR STE 8
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3682
Practice Address - Country:US
Practice Address - Phone:626-991-1804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty