Healthcare Provider Details

I. General information

NPI: 1104009190
Provider Name (Legal Business Name): SUZANNE M SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15675 AVENIDA ALCACHOFA APT B
SAN DIEGO CA
92128-4451
US

IV. Provider business mailing address

15675 AVENIDA ALCACHOFA APT B
SAN DIEGO CA
92128-4451
US

V. Phone/Fax

Practice location:
  • Phone: 619-955-2498
  • Fax:
Mailing address:
  • Phone: 619-955-2498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number321335-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW21250
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW122908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: