Provider Demographics
NPI:1801912936
Name:PROULX, SUSAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:PROULX
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 MARLBORO RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7825
Mailing Address - Country:US
Mailing Address - Phone:610-357-6180
Mailing Address - Fax:
Practice Address - Street 1:300 S CHESTER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1800
Practice Address - Country:US
Practice Address - Phone:610-357-6180
Practice Address - Fax:610-719-8574
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 004961 L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical