Doctor Name: | MRS. SUSMARIA CHARLES |
NPI Number: | 1124383914 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 595 Bethlehem Pike Suite 106 Montgomeryville, PA - 189369710 |
Business Phone Number: | 1215997200 |
Business Fax Number: | |
Mailing Address: | 144 Copley Rd, 1st Floor UPPER DARBY |
State: | PA |
Postal Code: | 190823103 |
Phone Number: | 4844664844 |
Fax Number: | |
NPI Enumeration Date: | 07/09/2012 |
NPI Last Update Date: | 07/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |