Provider Demographics
NPI:1265495006
Name:MATHES, SUSAN (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MATHES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHETWYND DR
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1453
Mailing Address - Country:US
Mailing Address - Phone:610-527-7712
Mailing Address - Fax:610-527-7702
Practice Address - Street 1:100 CHETWYND DR
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:PA
Practice Address - Zip Code:19010-1453
Practice Address - Country:US
Practice Address - Phone:610-527-7712
Practice Address - Fax:610-527-7702
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002488103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical