Provider Demographics
NPI:1275698417
Name:DELONE, SUSAN TALIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:TALIA
Last Name:DELONE
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 1:401 FAIRVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-1014
Mailing Address - Country:US
Mailing Address - Phone:215-862-8059
Mailing Address - Fax:215-862-8059
Practice Address - Street 1:401 FAIRVIEW WAY
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938-1014
Practice Address - Country:US
Practice Address - Phone:215-862-8059
Practice Address - Fax:215-862-8059
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007215L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA629285OtherHIGHMARK PA