Provider Demographics
NPI:1548000979
Name:SINGHAL, SUSIE (SUJATA) (ASW, MSW, MED, MPH)
Entity type:Individual
Prefix:MISS
First Name:SUSIE (SUJATA)
Middle Name:
Last Name:SINGHAL
Suffix:
Gender:F
Credentials:ASW, MSW, MED, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 CHEYNE WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3499
Mailing Address - Country:US
Mailing Address - Phone:310-663-6885
Mailing Address - Fax:
Practice Address - Street 1:2626 FOOTHILL BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3574
Practice Address - Country:US
Practice Address - Phone:310-663-6885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1227261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical