Provider Demographics
NPI:1760153399
Name:MACCIOCCA, SUSANNA BEERS
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:BEERS
Last Name:MACCIOCCA
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 1:1423 MILL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5979
Mailing Address - Country:US
Mailing Address - Phone:610-717-7666
Mailing Address - Fax:
Practice Address - Street 1:7 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1378
Practice Address - Country:US
Practice Address - Phone:484-393-5652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health