Provider Demographics
NPI:1093910853
Name:NEEDHAM, SUSAN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:NEEDHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MCDANIEL AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2532
Mailing Address - Country:US
Mailing Address - Phone:302-478-2999
Mailing Address - Fax:
Practice Address - Street 1:212 MCDANIEL AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2532
Practice Address - Country:US
Practice Address - Phone:302-478-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB10000403103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE013509P95Medicare ID - Type Unspecified