Provider Demographics
NPI:1366559601
Name:WHITMORE, SUSAN DIANE (MFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 EL MONTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109
Mailing Address - Country:US
Mailing Address - Phone:408-781-7275
Mailing Address - Fax:408-779-3677
Practice Address - Street 1:238 EL MONTE DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109
Practice Address - Country:US
Practice Address - Phone:408-781-7275
Practice Address - Fax:408-779-3677
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 19240106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT 19240OtherCALIFORNIA LICENSE