MEDICARE: SUZANNE DARULA LCSW

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	1041C0700X	Clinical Social Worker	CW018451	PA

General Provider Information

NPI Number	:	1598003907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE DARULA LCSW

Provider Business Mailing Address
First Line	:	16265 CONNEAUT LAKE RD
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16265 CONNEAUT LAKE RD
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-3861
Country	:	US
Telephone Number	:	814-807-1330
Fax Number	:

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

Provider Enumeration Date	:	01/18/2013
Last Update Date	:	02/24/2016

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