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General NPI Number Information
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NPI Number | 1528082765
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Entity Type | Individual
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Provider Name | SUSAN PATRICIA CAREY MFTI
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2183 FAIRVIEW RD 100
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City | COSTA MESA
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State | CA
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Zip | 92627-5663
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Country | US
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Telephone | 949-515-5440
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Fax | 949-515-5444
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Provider Business Mailing Address
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Address Line | 325 LEGION ST
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2426
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Country | US
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Telephone | 949-715-1050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMF 38841
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License Number State | CA
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