Provider Demographics
NPI:1366574642
Name:MCENANY, SUZAN S (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:S
Last Name:MCENANY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 HUNTINGTON DR
Mailing Address - Street 2:#101
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4552
Mailing Address - Country:US
Mailing Address - Phone:626-403-4370
Mailing Address - Fax:626-403-4260
Practice Address - Street 1:1499 HUNTINGTON DR
Practice Address - Street 2:#101
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4552
Practice Address - Country:US
Practice Address - Phone:626-403-4370
Practice Address - Fax:626-403-4260
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17036103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical