MEDICARE: SUSAN E HARNEY LMFT

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	106H00000X	Marriage & Family Therapist	MFC 33553	CA

General Provider Information

NPI Number	:	1881804151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN E HARNEY LMFT

Provider Business Mailing Address
First Line	:	625 14TH ST
Second Line	:	#B
City	:	PASO ROBLES
State	:	CA
Zip	:	93446
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 14TH ST STE B
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-7213
Country	:	US
Telephone Number	:	805-781-3535
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	10/20/2017

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