Healthcare Provider Details

I. General information

NPI: 1447332440
Provider Name (Legal Business Name): ANDREA SUSSEL MSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 MONUMENT ROAD BELMONT CENTER
PHILAELPHIA PA
19131
US

IV. Provider business mailing address

2947 MAPLESHADE RD
ARDMORE PA
19003-1820
US

V. Phone/Fax

Practice location:
  • Phone: 215-581-9142
  • Fax: 215-581-3827
Mailing address:
  • Phone: 215-581-9142
  • Fax: 215-581-3827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014864
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: