Provider Demographics
NPI:1992822068
Name:MENDENHALL, SUSAN LEE (MSW PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:MSW PSYD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10436 SANTA MONICA BLVD
Mailing Address - Street 2:#3050
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-558-8091
Mailing Address - Fax:310-204-4028
Practice Address - Street 1:10436 SANTA MONICA BLVD
Practice Address - Street 2:#3050
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-558-8091
Practice Address - Fax:310-204-4028
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CALCS32841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical