Healthcare Provider Details

I. General information

NPI: 1760153399
Provider Name (Legal Business Name): SUSANNA BEERS MACCIOCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 E SWEDESFORD RD STE 410F
EXTON PA
19341-2466
US

IV. Provider business mailing address

1423 MILL CREEK DR
WEST CHESTER PA
19380-5979
US

V. Phone/Fax

Practice location:
  • Phone: 484-393-5652
  • Fax:
Mailing address:
  • Phone: 610-717-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC017362
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: