Provider Demographics
NPI:1124383914
Name:CHARLES, SUSMARIA (MHS)
Entity Type:Individual
Prefix:MRS
First Name:SUSMARIA
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 AVENEL BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-3947
Mailing Address - Country:US
Mailing Address - Phone:484-466-4844
Mailing Address - Fax:
Practice Address - Street 1:320 MACDADE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-1926
Practice Address - Country:US
Practice Address - Phone:610-522-4506
Practice Address - Fax:610-522-4508
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health