Active NPI
Susan Jean Brundo, MA, MFT
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1174884084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC24357
- Practice address
- 2550 Overland Ave
Suite 100
Los Angeles, CA 90064-3346 - Phone
- (310) 552-8027
- NPI assigned
- Jun 6, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC24357 | CA | Primary |
Addresses
Primary practice location
2550 Overland Ave
Suite 100
Los Angeles, CA 90064-3346
Mailing address
2550 Overland Ave
Suite 100
Los Angeles, CA 90064-3346
Phone (310) 552-8027
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 12, 2024 through Jul 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC24357 | CA | MD | Marriage & Family Therapist |
| 24357 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338940800000",
"number": "1174884084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2550 OVERLAND AVE",
"address_2": "SUITE 100",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900643346",
"telephone_number": "310-552-8027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2550 OVERLAND AVE",
"address_2": "SUITE 100",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900643346",
"telephone_number": "310-552-8027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNDO",
"first_name": "SUSAN",
"middle_name": "JEAN",
"name_prefix": "Mrs.",
"credential": "MA, MFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-06",
"last_updated": "2012-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC24357",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.