Provider Demographics
NPI:1306995394
Name:PERRICELLI, SUSAN G (MA, LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:PERRICELLI
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1501
Mailing Address - Country:US
Mailing Address - Phone:215-836-7040
Mailing Address - Fax:
Practice Address - Street 1:806 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1501
Practice Address - Country:US
Practice Address - Phone:215-836-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003326101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional