Provider Demographics
NPI:1407245491
Name:HALAS, SUSANNAH JANE (MS)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:JANE
Last Name:HALAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SUSANNAH
Other - Middle Name:JANE
Other - Last Name:BRACKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:976 VISTA GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2418
Mailing Address - Country:US
Mailing Address - Phone:914-563-9490
Mailing Address - Fax:
Practice Address - Street 1:5648 FRIENDSHIP AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3610
Practice Address - Country:US
Practice Address - Phone:412-661-1827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000499101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health