Provider Demographics
NPI:1831394600
Name:METRICK, SUSAN LEIGH (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEIGH
Last Name:METRICK
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 1:128 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4029
Mailing Address - Country:US
Mailing Address - Phone:610-935-2510
Mailing Address - Fax:
Practice Address - Street 1:125 COULTER AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2410
Practice Address - Country:US
Practice Address - Phone:610-647-6406
Practice Address - Fax:610-642-0818
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015658103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist