Provider Demographics
NPI:1689636706
Name:REGO, SUSAN DEUTSCHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DEUTSCHER
Last Name:REGO
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 1:2045 WESTGATE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017
Mailing Address - Country:US
Mailing Address - Phone:610-332-1705
Mailing Address - Fax:610-332-1707
Practice Address - Street 1:2045 WESTGATE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017
Practice Address - Country:US
Practice Address - Phone:610-332-1705
Practice Address - Fax:610-332-1707
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005056L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA518818OtherHIGHMARK BS
PA02762600OtherCAPITAL BLUE CROSS
DE518818Medicare ID - Type Unspecified