Active NPI
Susan M Jorgensen, MFT
- Marriage & Family Therapist
- La Jolla, CA
National Provider Identifier
1962670109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFT22281
- Practice address
- 4225 Executive SQ
#1110
La Jolla, CA 92037 - Phone
- (858) 622-0632
- NPI assigned
- Feb 11, 2008
- Sex
- Female
- Sole proprietor
- No
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 | MFT22281 | CA | Primary |
Addresses
Primary practice location
4225 Executive SQ
#1110
La Jolla, CA 92037
Mailing address
4225 Executive SQ
#1110
La Jolla, CA 92037
Phone (858) 622-0632
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFT22281 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202688000000",
"number": "1962670109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4225 EXECUTIVE SQ",
"address_2": "#1110",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "92037",
"telephone_number": "858-622-0632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4225 EXECUTIVE SQ",
"address_2": "#1110",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "92037",
"telephone_number": "858-622-0632"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORGENSEN",
"first_name": "SUSAN",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "MFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-11",
"last_updated": "2008-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFT22281",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Jolla, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.