Provider Demographics
NPI:1043554660
Name:ROOP, SUSAN LYNN (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:ROOP
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 562
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:PA
Mailing Address - Zip Code:16052-0562
Mailing Address - Country:US
Mailing Address - Phone:724-504-8164
Mailing Address - Fax:
Practice Address - Street 1:1227 SUNSET DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-0781
Practice Address - Country:US
Practice Address - Phone:724-504-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional