Provider Demographics
NPI:1699074211
Name:STONE, SUSAN C (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:C
Last Name:STONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5618 OSTROM AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1404
Mailing Address - Country:US
Mailing Address - Phone:818-343-0399
Mailing Address - Fax:
Practice Address - Street 1:5618 OSTROM AVE
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1404
Practice Address - Country:US
Practice Address - Phone:818-343-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS6013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health