Provider Demographics
NPI:1487976643
Name:LONGWELL, SUSANNE LEA (LCSW, PPSC)
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:LEA
Last Name:LONGWELL
Suffix:
Gender:F
Credentials:LCSW, PPSC
Other - Prefix:MISS
Other - First Name:SUSANNE
Other - Middle Name:LEA
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, PPSC
Mailing Address - Street 1:4383 CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1526
Mailing Address - Country:US
Mailing Address - Phone:619-573-8519
Mailing Address - Fax:
Practice Address - Street 1:4383 CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1526
Practice Address - Country:US
Practice Address - Phone:619-258-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA653041041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical