Provider Demographics
NPI:1922713510
Name:ALEXANDER, SUSAN MILLER
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MILLER
Last Name:ALEXANDER
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 1:806 PEMBROKE LN
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2064
Mailing Address - Country:US
Mailing Address - Phone:484-535-0944
Mailing Address - Fax:
Practice Address - Street 1:95 HOWELLVILLE RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1307
Practice Address - Country:US
Practice Address - Phone:610-647-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014933101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health