Healthcare Provider Details

I. General information

NPI: 1174446181
Provider Name (Legal Business Name): SUSAN KNORR-WATSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 2ND AVE
MALVERN PA
19355-3029
US

IV. Provider business mailing address

9 2ND AVE
MALVERN PA
19355-3029
US

V. Phone/Fax

Practice location:
  • Phone: 631-312-2928
  • Fax:
Mailing address:
  • Phone: 631-312-2928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP036746
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: