Healthcare Provider Details

I. General information

NPI: 1942790480
Provider Name (Legal Business Name): SUSANNA EILEEN WRIGHT LCSW, MSW, CADCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000B S CENTER DR
CLEARLAKE CA
95422-8131
US

IV. Provider business mailing address

7000B S CENTER DR
CLEARLAKE CA
95422-8131
US

V. Phone/Fax

Practice location:
  • Phone: 707-994-7090
  • Fax: 707-994-7164
Mailing address:
  • Phone: 707-994-7090
  • Fax: 707-994-7164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: