Provider Demographics
NPI:1679854657
Name:FRIXIONE, SUSAN THOMAS (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:THOMAS
Last Name:FRIXIONE
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 AVENIDA SEVILLA UNIT B
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-8344
Mailing Address - Country:US
Mailing Address - Phone:661-965-6954
Mailing Address - Fax:
Practice Address - Street 1:570 AVENIDA SEVILLA UNIT B
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-8344
Practice Address - Country:US
Practice Address - Phone:661-965-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14321103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical