Provider Demographics
NPI:1043231772
Name:IRWIN, SUSAN GROVE (NCC, LPC, CCPD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GROVE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:NCC, LPC, CCPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 E LANCASTER AVE
Mailing Address - Street 2:LOWER LEVEL WEST
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2776
Mailing Address - Country:US
Mailing Address - Phone:610-518-6020
Mailing Address - Fax:610-518-3892
Practice Address - Street 1:506 E LANCASTER AVE
Practice Address - Street 2:LOWER LEVEL WEST
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2776
Practice Address - Country:US
Practice Address - Phone:610-518-6020
Practice Address - Fax:610-518-3892
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC00990101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007396050010Medicaid