Healthcare Provider Details

I. General information

NPI: 1033646005
Provider Name (Legal Business Name): SUSAN DEIKMAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2017
Last Update Date: 05/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 OLD YORK RD CARRIAGE HOUSE
ELKINS PARK PA
19027-3005
US

IV. Provider business mailing address

8222 WESTMINSTER RD
ELKINS PARK PA
19027-1409
US

V. Phone/Fax

Practice location:
  • Phone: 215-586-1865
  • Fax: 512-853-2523
Mailing address:
  • Phone: 12155861865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH003162
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN DEIKMAN
Title or Position: MANAGING PARTNER
Credential: MS, BCBA, LBS
Phone: 215-586-1865