Basic Information
| Provider Information | |||||||||
| NPI: | 1013048313 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SORENSEN | ||||||||
| FirstName: | SUE | ||||||||
| MiddleName: | NOVACK | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1852 MARY RD | ||||||||
| Address2: | |||||||||
| City: | ACTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935101493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612692290 | ||||||||
| FaxNumber: | 6612692213 | ||||||||
| Practice Location | |||||||||
| Address1: | 12450 VAN NUYS BLVD | ||||||||
| Address2: | 100 | ||||||||
| City: | PACOIMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913311391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188968366 | ||||||||
| FaxNumber: | 8188968392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS 13709 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.