Provider Demographics
NPI:1194903666
Name:MATOUR, SUSAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MATOUR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LOCUST ST
Mailing Address - Street 2:APT 15B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3934
Mailing Address - Country:US
Mailing Address - Phone:215-928-2019
Mailing Address - Fax:
Practice Address - Street 1:1503 LANSDOWNE AVE
Practice Address - Street 2:3008
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-237-4554
Practice Address - Fax:610-237-2627
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical