Provider Demographics
NPI:1801882717
Name:GLASKIN, SUSAN (PSY D)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:GLASKIN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 S BROAD ST
Mailing Address - Street 2:STE 220
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5395
Mailing Address - Country:US
Mailing Address - Phone:215-699-3901
Mailing Address - Fax:215-699-3909
Practice Address - Street 1:1240 S BROAD ST
Practice Address - Street 2:STE 220
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5395
Practice Address - Country:US
Practice Address - Phone:215-699-3901
Practice Address - Fax:215-699-3909
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004177L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0438400000OtherAMERIHEALTH
PA0438400000OtherAMERIHEALTH
R07530Medicare UPIN