Provider Demographics
NPI:1902359433
Name:SUSAN G PERRICELLI LICENSED PROFESSIONAL COUNSELOR, LLC
Entity Type:Organization
Organization Name:SUSAN G PERRICELLI LICENSED PROFESSIONAL COUNSELOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PERRICELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:215-840-3477
Mailing Address - Street 1:806 BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1501
Mailing Address - Country:US
Mailing Address - Phone:215-840-3477
Mailing Address - Fax:
Practice Address - Street 1:806 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1501
Practice Address - Country:US
Practice Address - Phone:215-840-3477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty