Provider Demographics
NPI:1316003049
Name:WALSH FELIZZI, SUSANNE M (MSS, LCSW)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:M
Last Name:WALSH FELIZZI
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:M
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSS, LCSW
Mailing Address - Street 1:1100 POWELL ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3820
Mailing Address - Country:US
Mailing Address - Phone:610-277-4600
Mailing Address - Fax:
Practice Address - Street 1:1201 DEKALB ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3415
Practice Address - Country:US
Practice Address - Phone:610-279-9270
Practice Address - Fax:610-279-4146
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0145121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P96655Medicare UPIN
PA072622GNYMedicare ID - Type Unspecified