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General NPI Number Information
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NPI Number | 1114392552
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Entity Type | Organization
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Legal Business Name | SUSQUEHANNA PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 20 CLEARFIELD STREET
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City | ELIZABETHVILLE
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State | PA
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Zip | 17023-6603
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Country | US
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Telephone | 717-362-8900
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Fax | 717-362-8910
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Provider Business Mailing Address
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Address Line | PO BOX 739
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City | ELIZABETHVILLE
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State | PA
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Zip | 17023-0739
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Country | US
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Telephone | 717-362-8900
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Fax | 717-362-8910
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CYNTHIA C STAUFFER
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Credential | MS
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Telephone | 717-362-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | P5006799L
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License Number State | PA
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