=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194633081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEREN SUSSMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2026
-----------------------------------------------------
Last Update Date | 08/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12553 KILLION ST
-----------------------------------------------------
City | VALLEY VILLAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91607-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-333-0199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1753 S WOOSTER ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90035-4332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-321-1834
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------