MEDICARE: MS. SUSAN CHRISTINE LAYTHE LCSW

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	1041C0700X	Clinical Social Worker	CW019478	PA

General Provider Information

NPI Number	:	1760783237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN CHRISTINE LAYTHE LCSW

Provider Business Mailing Address
First Line	:	435 CHESTNUT ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-4404
Country	:	US
Telephone Number	:	814-807-0861
Fax Number	:	814-807-0863

Provider Business Practice Location Address
First Line	:	435 CHESTNUT ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-4404
Country	:	US
Telephone Number	:	814-807-0861
Fax Number	:	814-807-0863

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

Provider Enumeration Date	:	11/15/2010
Last Update Date	:	06/12/2019

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