Healthcare Provider Details

I. General information

NPI: 1679018915
Provider Name (Legal Business Name): SUSAN HEFNER ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11046 MAIN ST
EL MONTE CA
91731-2617
US

IV. Provider business mailing address

11046 MAIN ST
EL MONTE CA
91731-2617
US

V. Phone/Fax

Practice location:
  • Phone: 626-663-2370
  • Fax:
Mailing address:
  • Phone: 626-663-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1235671116
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2013593II
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: