Provider Demographics
NPI:1316171713
Name:GEORGE, SUZANNE M (PHD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:GRIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:192 MANSION RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073
Mailing Address - Country:US
Mailing Address - Phone:215-947-8654
Mailing Address - Fax:215-938-7607
Practice Address - Street 1:2910 FRANKS RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4255
Practice Address - Country:US
Practice Address - Phone:215-947-8654
Practice Address - Fax:215-938-7607
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2019-08-28
Deactivation Date:2019-08-09
Deactivation Code:
Reactivation Date:2019-08-28
Provider Licenses
StateLicense IDTaxonomies
PAPS016545103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist