MEDICARE: SUSAN MAURIZIO

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	103K00000X	Behavior Analyst	BH001551	PA
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1841727161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MAURIZIO

Provider Business Mailing Address
First Line	:	358 ZANE AVE
Second Line	:
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-4315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 COUNTY LINE RD STE 413
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-1717
Country	:	US
Telephone Number	:	267-388-0670
Fax Number	:

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

Provider Enumeration Date	:	05/17/2017
Last Update Date	:	05/17/2017

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Directions to “ SUSAN MAURIZIO ” Practice Location

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