Provider Demographics
NPI:1164844189
Name:SCHLASTA, SUSAN (LCSW, BCD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SCHLASTA
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WASHINGTON AVE APT A
Mailing Address - Street 2:
Mailing Address - City:JERMYN
Mailing Address - State:PA
Mailing Address - Zip Code:18433-1327
Mailing Address - Country:US
Mailing Address - Phone:570-876-5439
Mailing Address - Fax:
Practice Address - Street 1:401 WASHINGTON AVE APT A
Practice Address - Street 2:
Practice Address - City:JERMYN
Practice Address - State:PA
Practice Address - Zip Code:18433-1327
Practice Address - Country:US
Practice Address - Phone:570-876-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0131721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical