Healthcare Provider Details

I. General information

NPI: 1831394600
Provider Name (Legal Business Name): SUSAN LEIGH METRICK PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 COULTER AVE
ARDMORE PA
19003-2410
US

IV. Provider business mailing address

128 PENNSYLVANIA AVE
PHOENIXVILLE PA
19460-4029
US

V. Phone/Fax

Practice location:
  • Phone: 610-647-6406
  • Fax: 610-642-0818
Mailing address:
  • Phone: 610-935-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS015658
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: