Provider Demographics
NPI:1316121718
Name:WORTH, SUSAN EILEEN (MED)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:EILEEN
Last Name:WORTH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 EASTON RD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1922
Mailing Address - Country:US
Mailing Address - Phone:215-830-8430
Mailing Address - Fax:215-830-8432
Practice Address - Street 1:1120 EASTON RD
Practice Address - Street 2:SUITE ONE
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1922
Practice Address - Country:US
Practice Address - Phone:215-830-8430
Practice Address - Fax:215-830-8432
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003702-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist