Provider Demographics
NPI:1194938514
Name:GOLDSTEIN, SUZANNE GROSSMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:GROSSMAN
Last Name:GOLDSTEIN
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 1:455 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3403
Mailing Address - Country:US
Mailing Address - Phone:215-653-0363
Mailing Address - Fax:215-653-0361
Practice Address - Street 1:455 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3403
Practice Address - Country:US
Practice Address - Phone:215-653-0363
Practice Address - Fax:215-653-0361
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016158103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent