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General NPI Number Information
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NPI Number | 1871838433
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Entity Type | Individual
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Provider Name | SUSANN ANDERSON PSYD
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Gender | Female
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | UNIVERSITY DRIVE
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City | PITTSBURGH
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State | PA
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Zip | 15240
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Country | US
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Telephone | 412-360-6093
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 TAYLOR RIDGE CT
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City | ERIE
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State | PA
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Zip | 16505-2658
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Country | US
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Telephone | 814-440-6104
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PSYCHOLOGY TRAINEE
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS018390
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License Number State | PA
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