Healthcare Provider Details

I. General information

NPI: 1861680282
Provider Name (Legal Business Name): SUSAN MATSUI LCSW, PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 SOQUEL DR STE 500
SOQUEL CA
95073-2850
US

IV. Provider business mailing address

PO BOX 505
CAPITOLA CA
95010-0505
US

V. Phone/Fax

Practice location:
  • Phone: 831-425-3141
  • Fax:
Mailing address:
  • Phone: 831-425-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 23638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: