MEDICARE: SUSANNAH BONN MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1174229272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNAH BONN MFT

Provider Business Mailing Address
First Line	:	1813 SPRUCE ST APT 3R
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-5806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 RITTENHOUSE SQ
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-5837
Country	:	US
Telephone Number	:	215-839-6685
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	02/01/2023

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