Provider Demographics
NPI:1245596287
Name:BAUER, SUZANNE (PSYD, JD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:PSYD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 FORD RD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2824
Mailing Address - Country:US
Mailing Address - Phone:215-878-3400
Mailing Address - Fax:215-878-2082
Practice Address - Street 1:3905 FORD RD
Practice Address - Street 2:SUITE #6
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2824
Practice Address - Country:US
Practice Address - Phone:215-878-3400
Practice Address - Fax:215-878-2082
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133660101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007283430002Medicaid