Provider Demographics
NPI:1710171301
Name:REZIN, SUSAN (LMFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:REZIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19414 CORDELIA AVE
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-7532
Mailing Address - Country:US
Mailing Address - Phone:097-683-8252
Mailing Address - Fax:
Practice Address - Street 1:19414 CORDELIA AVE
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-7532
Practice Address - Country:US
Practice Address - Phone:209-768-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist