Basic Information
| Provider Information | |||||||||
| NPI: | 1003274515 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHOI | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | MYUNGHEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHOI | ||||||||
| OtherFirstName: | MYUNGHEE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 470 CHADBOURNE RD. SUITE E | ||||||||
| Address2: | ALDEA CHILDREN & FAMILY SERVICES | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945349600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074259670 | ||||||||
| FaxNumber: | 7074259880 | ||||||||
| Practice Location | |||||||||
| Address1: | 470 CHADBOURNE RD. SUITE E | ||||||||
| Address2: | ALDEA CHILDREN & FAMILY SERVICES | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945349600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074259670 | ||||||||
| FaxNumber: | 7074259880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2016 | ||||||||
| LastUpdateDate: | 01/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW62160 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | LCSW81087 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | LCSW81087 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.