Provider Demographics
NPI:1114462348
Name:DEIKMAN, SUSAN (MS, BCBA, LBS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DEIKMAN
Suffix:
Gender:F
Credentials:MS, BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:215-586-1865
Mailing Address - Fax:
Practice Address - Street 1:8222 WESTMINSTER RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1409
Practice Address - Country:US
Practice Address - Phone:215-586-1865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-26
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003162103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst