Basic Information
| Provider Information | |||||||||
| NPI: | 1104095918 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMASAKI | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT 50982 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 MAREBLU | ||||||||
| Address2: | |||||||||
| City: | ALISO VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926563014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496436950 | ||||||||
| FaxNumber: | 9496436981 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 MAREBLU | ||||||||
| Address2: | |||||||||
| City: | ALISO VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926563014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496436950 | ||||||||
| FaxNumber: | 9496436981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2008 | ||||||||
| LastUpdateDate: | 10/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT50982 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.