Provider Demographics
NPI:1164729703
Name:EMMINGER, SUSAN JAYNE (LSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JAYNE
Last Name:EMMINGER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20722 ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-4126
Mailing Address - Country:US
Mailing Address - Phone:814-337-2333
Mailing Address - Fax:
Practice Address - Street 1:20722 ALDEN ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-4126
Practice Address - Country:US
Practice Address - Phone:814-337-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128132104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker