MEDICARE: SUSANNAH HALSEY LPC

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	101YP2500X	Professional Counselor	PC016799	PA

General Provider Information

NPI Number	:	1285485193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNAH HALSEY LPC

Provider Business Mailing Address
First Line	:	1050 E MONTGOMERY AVE APT 204
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3448
Country	:	US
Telephone Number	:	202-560-7321
Fax Number	:

Provider Business Practice Location Address
First Line	:	7340 JACKSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-4008
Country	:	US
Telephone Number	:	267-975-1466
Fax Number	:

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

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	03/28/2024

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Directions to “ SUSANNAH HALSEY LPC” Practice Location

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