Provider Demographics
NPI:1922136803
Name:MALLAGHAN RASCO, SUZANNE P (LICENSED PA PSYCHOLO)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:P
Last Name:MALLAGHAN RASCO
Suffix:
Gender:F
Credentials:LICENSED PA PSYCHOLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081
Mailing Address - Country:US
Mailing Address - Phone:610-446-1936
Mailing Address - Fax:
Practice Address - Street 1:630 FAIRVIEW RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-2336
Practice Address - Country:US
Practice Address - Phone:610-446-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006146L103TC0700X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0743570000Medicare UPIN