Provider Demographics
NPI:1194092460
Name:WINSTON, SUSAN B (MFT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:B
Last Name:WINSTON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:B
Other - Last Name:WINSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:10894 WILLOWCREST PL
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3927
Mailing Address - Country:US
Mailing Address - Phone:818-618-0774
Mailing Address - Fax:818-761-1224
Practice Address - Street 1:10894 WILLOWCREST PL
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3927
Practice Address - Country:US
Practice Address - Phone:818-618-0774
Practice Address - Fax:818-761-1224
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC49864106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist