Provider Demographics
NPI:1194161398
Name:NARDELLA, SUSAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:NARDELLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 HILLSIDE DR
Mailing Address - Street 2:CLARKS SUMMIT STATE HOSPITAL - PSYCHOLOGY DEPARTMENT
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9504
Mailing Address - Country:US
Mailing Address - Phone:570-587-9717
Mailing Address - Fax:570-587-7126
Practice Address - Street 1:1451 HILLSIDE DR
Practice Address - Street 2:CLARKS SUMMIT STATE HOSPITAL - PSYCHOLOGY DEPARTMENT
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9504
Practice Address - Country:US
Practice Address - Phone:570-587-9717
Practice Address - Fax:570-587-7126
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS017378103TC0700X
NY019973103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical