Provider Demographics
NPI:1154545044
Name:DOGAN, SUSAN REGINA (LPC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:REGINA
Last Name:DOGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 1990
Mailing Address - Street 2:SYLVAN CASCADE ROAD
Mailing Address - City:HENRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18332-9137
Mailing Address - Country:US
Mailing Address - Phone:570-629-8711
Mailing Address - Fax:570-629-9570
Practice Address - Street 1:RR 1 BOX 1990
Practice Address - Street 2:SYLVAN CASCADE ROAD
Practice Address - City:HENRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18332-9137
Practice Address - Country:US
Practice Address - Phone:570-629-8711
Practice Address - Fax:570-629-9570
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1965101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional