Healthcare Provider Details

I. General information

NPI: 1922259084
Provider Name (Legal Business Name): SUSAN JANE ALONSO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 GRAND OAK CT
WALNUT CREEK CA
94598-3952
US

IV. Provider business mailing address

2977 YGNACIO VALLEY RD #425
WALNUT CREEK CA
94598-3535
US

V. Phone/Fax

Practice location:
  • Phone: 925-330-5711
  • Fax:
Mailing address:
  • Phone: 925-330-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number65208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: