Provider Demographics
NPI:1285949370
Name:DECESARE, SUSAN D (PSY D)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:D
Last Name:DECESARE
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 DALEVILLE HIGHWAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COVINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18444
Mailing Address - Country:US
Mailing Address - Phone:570-212-1518
Mailing Address - Fax:
Practice Address - Street 1:260 DALEVILLE HIGHWAY
Practice Address - Street 2:SUITE 105
Practice Address - City:COVINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18444
Practice Address - Country:US
Practice Address - Phone:570-212-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016835103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical