Provider Demographics
NPI:1992073522
Name:MOSIER, SUSAN (LMFT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MOSIER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:MOSIER-DELGADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 PACIFIC AVE #329
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:408-332-9382
Mailing Address - Fax:
Practice Address - Street 1:130 N. JACKSON AVE.
Practice Address - Street 2:ON LOK PACE
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-795-3837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45008106H00000X
CA45008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist