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General NPI Number Information
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NPI Number | 1790153989
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Entity Type | Individual
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Provider Name | SUSAN L VANG LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 857 W CHILDS AVE
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City | MERCED
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State | CA
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Zip | 95341
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Country | US
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Telephone | 209-385-5600
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Fax | 209-385-5674
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Provider Business Mailing Address
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Address Line | 737 W CHILDS AVE
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City | MERCED
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State | CA
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Zip | 95341-6805
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Country | US
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Telephone | 209-384-6488
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Fax | 855-202-9336
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 62280
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 89152
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License Number State | CA
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