Healthcare Provider Details

I. General information

NPI: 1841727161
Provider Name (Legal Business Name): SUSAN MAURIZIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 COUNTY LINE RD STE 413
HUNTINGDON VALLEY PA
19006-1717
US

IV. Provider business mailing address

358 ZANE AVE
JENKINTOWN PA
19046-4315
US

V. Phone/Fax

Practice location:
  • Phone: 267-388-0670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH001551
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: