Provider Demographics
NPI:1376899286
Name:AVRICH, SUSAN BETH (MA, LPC, CAADC)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:BETH
Last Name:AVRICH
Suffix:
Gender:F
Credentials:MA, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4452
Mailing Address - Country:US
Mailing Address - Phone:610-704-2860
Mailing Address - Fax:
Practice Address - Street 1:4032 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4452
Practice Address - Country:US
Practice Address - Phone:610-704-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6961101YA0400X
PAPC005027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)