Provider Demographics
NPI:1598378663
Name:ANDERSON, SUZANNE BANNING (LCSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BANNING
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 WALNUT ST.
Mailing Address - Street 2:SAYRE HIGH SCHOOL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139
Mailing Address - Country:US
Mailing Address - Phone:484-393-1174
Mailing Address - Fax:
Practice Address - Street 1:SAYRE HIGH SCHOOL
Practice Address - Street 2:5800 WALNUT ST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139
Practice Address - Country:US
Practice Address - Phone:484-393-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0211671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical