MEDICARE: DR. SUZAN S. MCENANY PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	17036	CA

General Provider Information

NPI Number	:	1366574642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZAN S. MCENANY PSY.D.

Provider Business Mailing Address
First Line	:	1499 HUNTINGTON DR
Second Line	:	#101
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4552
Country	:	US
Telephone Number	:	626-403-4370
Fax Number	:	626-403-4260

Provider Business Practice Location Address
First Line	:	1499 HUNTINGTON DR
Second Line	:	#101
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4552
Country	:	US
Telephone Number	:	626-403-4370
Fax Number	:	626-403-4260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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