Provider Demographics
NPI:1033646005
Name:SUSAN DEIKMAN LLC
Entity Type:Organization
Organization Name:SUSAN DEIKMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBS
Authorized Official - Phone:215-586-1865
Mailing Address - Street 1:8222 WESTMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1409
Mailing Address - Country:US
Mailing Address - Phone:1215-586-1865
Mailing Address - Fax:
Practice Address - Street 1:7401 OLD YORK RD
Practice Address - Street 2:CARRIAGE HOUSE
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3005
Practice Address - Country:US
Practice Address - Phone:215-586-1865
Practice Address - Fax:512-853-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-21
Last Update Date:2017-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003162103K00000X
106E00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty