Provider Demographics
NPI:1962059667
Name:FERENCZ, SUSAN CAROLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CAROLE
Last Name:FERENCZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 E LA PALMA AVE STE 100D
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2056
Mailing Address - Country:US
Mailing Address - Phone:714-337-9465
Mailing Address - Fax:714-779-1306
Practice Address - Street 1:5101 E LA PALMA AVE STE 100D
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2056
Practice Address - Country:US
Practice Address - Phone:714-337-9465
Practice Address - Fax:714-779-1306
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP3662103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist