Healthcare Provider Details

I. General information

NPI: 1821409194
Provider Name (Legal Business Name): SUSAN L ZURICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 CASTOR AVE
PHILADELPHIA PA
19152-2729
US

IV. Provider business mailing address

8220 CASTOR AVE
PHILADELPHIA PA
19152-2729
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-4615
  • Fax: 215-745-6511
Mailing address:
  • Phone: 215-728-4615
  • Fax: 215-745-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC 000545
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: