Healthcare Provider Details

I. General information

NPI: 1720465701
Provider Name (Legal Business Name): SUSAN A SEYMOUR LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COMMERCE PARK DR SUITE 110
WILLIAMSPORT PA
17701-5475
US

IV. Provider business mailing address

320 HIGHLAND DR P.O. BOX 597
MOUNTVILLE PA
17554-1232
US

V. Phone/Fax

Practice location:
  • Phone: 570-323-6944
  • Fax: 570-323-4529
Mailing address:
  • Phone: 717-285-7121
  • Fax: 717-285-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW132273
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: