Provider Demographics
NPI:1467899518
Name:CORNBLUTH, SUSAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:CORNBLUTH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 N FIEDLER ROAD
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002
Mailing Address - Country:US
Mailing Address - Phone:267-261-8462
Mailing Address - Fax:
Practice Address - Street 1:1509 N FIEDLER RD
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2718
Practice Address - Country:US
Practice Address - Phone:267-261-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty