Provider Demographics
NPI:1447524582
Name:FIERBERG, SUSAN (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:FIERBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4557 HASKELL AVE
Mailing Address - Street 2:UNIT 302
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3152
Mailing Address - Country:US
Mailing Address - Phone:818-398-7618
Mailing Address - Fax:
Practice Address - Street 1:4557 HASKELL AVE
Practice Address - Street 2:UNIT 302
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3152
Practice Address - Country:US
Practice Address - Phone:818-398-7618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical