Provider Demographics
NPI:1699489401
Name:SUSIE RO, LICENSED CLINICAL SOCIAL WORKER, PATH TO HEALING, INC,
Entity type:Organization
Organization Name:SUSIE RO, LICENSED CLINICAL SOCIAL WORKER, PATH TO HEALING, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-260-5705
Mailing Address - Street 1:1880 CAMINO DE LA REINA # 1086
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1539
Mailing Address - Country:US
Mailing Address - Phone:619-776-9408
Mailing Address - Fax:
Practice Address - Street 1:3990 OLD TOWN AVE STE A208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2967
Practice Address - Country:US
Practice Address - Phone:619-776-9408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health