Provider Demographics
NPI:1093530065
Name:TASSIN, SUSAN CAROL
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CAROL
Last Name:TASSIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 GREENBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-7248
Mailing Address - Country:US
Mailing Address - Phone:717-398-5660
Mailing Address - Fax:
Practice Address - Street 1:191 S EAST ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5918
Practice Address - Country:US
Practice Address - Phone:717-398-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool