MEDICARE: DR. SUSAN CAROLE FERENCZ 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	103T00000X	Psychologist	LEP3662	CA
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1962059667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN CAROLE FERENCZ PSY.D.

Provider Business Mailing Address
First Line	:	5101 E LA PALMA AVE STE 100D
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-2056
Country	:	US
Telephone Number	:	714-337-9465
Fax Number	:	714-779-1306

Provider Business Practice Location Address
First Line	:	5101 E LA PALMA AVE STE 100D
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-2056
Country	:	US
Telephone Number	:	714-337-9465
Fax Number	:	714-779-1306

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

Provider Enumeration Date	:	08/19/2019
Last Update Date	:	10/26/2023

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