MEDICARE: SUSAN REEDER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	24188	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1201	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1215018791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN REEDER LCSW

Provider Business Mailing Address
First Line	:	3835 N FREEWAY BLVD STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1954
Country	:	US
Telephone Number	:	916-576-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	8950 VILLA LA JOLLA DR STE C121
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-1707
Country	:	US
Telephone Number	:	858-768-0028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	11/22/2024

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Directions to “ SUSAN REEDER LCSW” Practice Location

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