Doctor Name: | SUSAN G DERISO |
NPI Number: | 1356358071 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LSW CEAP |
License Number: | SW-002275E |
Business Practice Address: | 508 Pittsburgh Street Suite 100 Mars, PA - 160463018 |
Business Phone Number: | 7246259450 |
Business Fax Number: | 7246259456 |
Mailing Address: | 508 Pittsburgh Street, P.o. Box 1285 MARS |
State: | PA |
Postal Code: | 160463018 |
Phone Number: | 7246259450 |
Fax Number: | 7246259456 |
NPI Enumeration Date: | 08/02/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | SW-002275E |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |