Provider Demographics
NPI:1912324344
Name:MUMBER, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MUMBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:V
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC
Mailing Address - Street 1:203 N MAIN ST
Mailing Address - Street 2:P.O. BOX 62
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-2385
Mailing Address - Country:US
Mailing Address - Phone:215-872-4219
Mailing Address - Fax:
Practice Address - Street 1:203 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-2385
Practice Address - Country:US
Practice Address - Phone:215-872-4219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACERTIFICATION 2777101YA0400X
PACERTIFICATION 100087101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)