MEDICARE: MRS. SUSAN JEAN THOMAS-BAUN MA

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	103TC1900X	Counseling Psychologist	PS007935L	PA

General Provider Information

NPI Number	:	1558492561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN JEAN THOMAS-BAUN MA

Provider Business Mailing Address
First Line	:	70 MARWOOD DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-2322
Country	:	US
Telephone Number	:	412-831-7694
Fax Number	:	412-831-7694

Provider Business Practice Location Address
First Line	:	200 OLD POND RD
Second Line	:
City	:	BRIDGEVILLE
State	:	PA
Zip	:	15017-1269
Country	:	US
Telephone Number	:	412-220-0144
Fax Number	:	412-220-0146

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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