Provider Demographics
NPI:1205143757
Name:SUZANNE L GRIERSON
Entity type:Organization
Organization Name:SUZANNE L GRIERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GRIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-226-4444
Mailing Address - Street 1:1258 PURDYTOWN TPKE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAKEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18438-6793
Mailing Address - Country:US
Mailing Address - Phone:570-226-4444
Mailing Address - Fax:570-226-4333
Practice Address - Street 1:1258 PURDYTOWN TPKE
Practice Address - Street 2:SUITE 2
Practice Address - City:LAKEVILLE
Practice Address - State:PA
Practice Address - Zip Code:18438-6793
Practice Address - Country:US
Practice Address - Phone:570-226-4444
Practice Address - Fax:570-226-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-04
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0149611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1192405M7Medicare UPIN
PA160320Medicare PIN