Provider Demographics
NPI:1114571239
Name:LEVIN, SUSAN D (MA, LPC, NCC, CCMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:LEVIN
Suffix:
Gender:F
Credentials:MA, LPC, NCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 S STATE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1549
Mailing Address - Country:US
Mailing Address - Phone:570-507-7714
Mailing Address - Fax:
Practice Address - Street 1:336 S STATE ST STE 5
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1549
Practice Address - Country:US
Practice Address - Phone:570-507-7714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013790101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional