Provider Demographics
NPI:1518981620
Name:CHERIAN, SUSAN - (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:-
Last Name:CHERIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BLACKHAWK ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1150
Mailing Address - Country:US
Mailing Address - Phone:412-242-5052
Mailing Address - Fax:412-242-5052
Practice Address - Street 1:134 BLACKHAWK STREET
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1150
Practice Address - Country:US
Practice Address - Phone:412-242-5052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007504L103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01849556Medicaid
PA01849556Medicaid