MEDICARE: MS. SUSAN EILEEN WORTH M.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS003702-L	PA

General Provider Information

NPI Number	:	1316121718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN EILEEN WORTH M.ED.

Provider Business Mailing Address
First Line	:	1120 EASTON RD
Second Line	:	SUITE ONE
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-1922
Country	:	US
Telephone Number	:	215-830-8430
Fax Number	:	215-830-8432

Provider Business Practice Location Address
First Line	:	1120 EASTON RD
Second Line	:	SUITE ONE
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-1922
Country	:	US
Telephone Number	:	215-830-8430
Fax Number	:	215-830-8432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	12/20/2007

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