Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS005971L | PA |
NPI | 1053336131 |
---|---|
Provider Name | Susan Boyer Drelick |
First Address | Oil City, PA 16301-2733 |
Second Address | Oil City, PA 16301-2733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 24/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060708 | VALUE OPTIONS (01) | PA |
209103 | UPMC (01) | PA |
250762000 | MAGELLAN (01) | PA |
513351 | BLUE SHIELD (01) | PA |
637594 | BLUE SHIELD (01) | PA |