Provider Demographics
NPI:1588713689
Name:SUSAN PEMBROKE
Entity type:Organization
Organization Name:SUSAN PEMBROKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PEMBROKE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:805-278-9585
Mailing Address - Street 1:500 E ESPLANADE DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2110
Mailing Address - Country:US
Mailing Address - Phone:805-278-9585
Mailing Address - Fax:805-659-4401
Practice Address - Street 1:500 E ESPLANADE DR
Practice Address - Street 2:SUITE 360
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2110
Practice Address - Country:US
Practice Address - Phone:805-278-9585
Practice Address - Fax:805-659-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29817106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty