Provider Demographics
NPI:1437447331
Name:DIETRICH, SUSAN K
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 BATH PIKE STE 501
Mailing Address - Street 2:SUITE 501
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2466
Mailing Address - Country:US
Mailing Address - Phone:610-417-0463
Mailing Address - Fax:
Practice Address - Street 1:3400 BATH PIKE
Practice Address - Street 2:SUITE 501
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-2466
Practice Address - Country:US
Practice Address - Phone:610-417-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1274171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical