Healthcare Provider Details

I. General information

NPI: 1548552573
Provider Name (Legal Business Name): SUSAN MARIE PRUSHINSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUE PRUSHINSKI NCC, LPC, CCPT

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 HONEY POT STREET - REAR
NANTICOKE PA
18634-1541
US

IV. Provider business mailing address

135 HONEY POT STREET - REAR
NANTICOKE PA
18634-1541
US

V. Phone/Fax

Practice location:
  • Phone: 570-933-2861
  • Fax: 570-276-2098
Mailing address:
  • Phone: 570-328-4070
  • Fax: 570-276-2098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC006669
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006669
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: