Provider Demographics
NPI:1417582776
Name:ST.LAWRENCE-SUSSMAN, DEBRA DEE (LMFT)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:DEE
Last Name:ST.LAWRENCE-SUSSMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 WEATHERVANE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-4226
Mailing Address - Country:US
Mailing Address - Phone:949-355-1022
Mailing Address - Fax:
Practice Address - Street 1:1000 QUAIL ST STE 155
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2765
Practice Address - Country:US
Practice Address - Phone:949-355-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty