Provider Demographics
NPI:1316051428
Name:NEVILLE, SUSAN DIANE (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W MAHONING ST
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-1919
Mailing Address - Country:US
Mailing Address - Phone:814-938-1830
Mailing Address - Fax:
Practice Address - Street 1:240 W MAHONING ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-1919
Practice Address - Country:US
Practice Address - Phone:814-938-1830
Practice Address - Fax:814-939-1982
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW015402104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker