Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 001170 | PA |
NPI | 1093923443 |
---|---|
Provider Name | Dr. Suzanne Mayer |
First Address | Springfield, PA 19064-1137 |
Second Address | Aston, PA 19014-1277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |