Provider Demographics
NPI:1801952288
Name:FARNSWORTH, SUSAN ELAINE (MED, LPC,CAC-D, SAP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELAINE
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:MED, LPC,CAC-D, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CAMP STRAUSS RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:PA
Mailing Address - Zip Code:19507-9564
Mailing Address - Country:US
Mailing Address - Phone:570-624-1148
Mailing Address - Fax:570-624-1148
Practice Address - Street 1:4 S 2ND ST
Practice Address - Street 2:SUITE 207
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3082
Practice Address - Country:US
Practice Address - Phone:570-624-1148
Practice Address - Fax:570-624-1148
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001801101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor