Healthcare Provider Details

I. General information

NPI: 1659172427
Provider Name (Legal Business Name): SUZANNE SWEZEA M.S, L.E.P. #4559
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17791 PRESCOTT LN
HUNTINGTON BEACH CA
92647-6431
US

IV. Provider business mailing address

17791 PRESCOTT LN
HUNTINGTON BEACH CA
92647-6431
US

V. Phone/Fax

Practice location:
  • Phone: 310-874-5731
  • Fax:
Mailing address:
  • Phone: 310-874-5731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number4559
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: