Provider Demographics
NPI:1861726317
Name:ST. JOHN, SUZANNE M (PHD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WASHINGTON LANE
Mailing Address - Street 2:SUITE A-8 WYNCOTE HOUSE
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095
Mailing Address - Country:US
Mailing Address - Phone:215-885-5585
Mailing Address - Fax:215-886-7472
Practice Address - Street 1:25 WASHINGTON LANE
Practice Address - Street 2:SUITE A-8 WYNCOTE HOUSE
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095
Practice Address - Country:US
Practice Address - Phone:215-885-5585
Practice Address - Fax:215-886-7472
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT098.0000151102L00000X
NYP85822102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT098.0000151OtherPSYCHOANALYST
098.0000151OtherPSYCHOANALYST