Provider Demographics
NPI:1215381280
Name:HEBERT, SUZANNE CAROL (LCSW, LICSW, DM)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:CAROL
Last Name:HEBERT
Suffix:
Gender:F
Credentials:LCSW, LICSW, DM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13080 MINDANAO WAY APT 87
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-8736
Mailing Address - Country:US
Mailing Address - Phone:978-855-1010
Mailing Address - Fax:
Practice Address - Street 1:13080 MINDANAO WAY APT 87
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-8736
Practice Address - Country:US
Practice Address - Phone:978-855-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1194671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical