Provider Demographics
NPI:1174831663
Name:MULDOON, SUZANNE MARIE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:MULDOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 REED RD FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-4008
Mailing Address - Country:US
Mailing Address - Phone:484-450-6476
Mailing Address - Fax:484-224-3398
Practice Address - Street 1:390 REED RD FL 1
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-4008
Practice Address - Country:US
Practice Address - Phone:484-450-6476
Practice Address - Fax:484-224-3398
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
PAPCPC001138101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical