Individual provider Active NPI

Susan Lynn Pavone, L.M.F.T.

  • Marriage & Family Therapist
  • Rancho Cucamonga, CA
National Provider Identifier
1407992456
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFC24231 Issued in CA
Practice address
8253 White Oak Ave
Rancho Cucamonga, CA 91730-7671
Phone
(909) 987-1997
Fax
(909) 987-0993
NPI assigned
Jan 29, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFC24231 CA Primary

Addresses

Primary practice location

8253 White Oak Ave
Rancho Cucamonga, CA 91730-7671

Mailing address

6644 Ventura PL
Alta Loma, CA 91701-4406

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240418001921 CA Practitioner - Marriage and Family Therapist 8022457449 Reassigns benefits to 2 organizations
Practice locations: Rancho Cucamonga, CA

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Foothills Psychological Services IncGroup PAC ID 9436157534, 37 clinicians

Practice addresses (Care Compare)

954 W Foothill Blvd
Suite a
Upland, CA 91786-3782
Phone (909) 946-4222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MFC24231CAMDMarriage & Family Therapist
24231CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Foothills Psychological Services, Inc. CurrentSince Dec 1, 2024 Accepting new patients

Locations

1550 N Park Ave
Pomona, CA 91768
Phone (909) 623-0791

10832 Laurel St
Ste 102
Rancho Cucamonga, CA 91730
Phone (909) 987-1997

954 W Foothill Blvd
Ste A
Upland, CA 91786
Phone (909) 946-4222

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407992456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6644 VENTURA PL",
            "city": "ALTA LOMA",
            "state": "CA",
            "postal_code": "917014406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8253 WHITE OAK AVE",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307671",
            "telephone_number": "909-987-1997",
            "fax_number": "909-987-0993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVONE",
        "first_name": "SUSAN",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "L.M.F.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC24231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

Verify at the official NPI Registry.