Provider Demographics
NPI:1326857780
Name:SURUBARU, PATRICIA MARIE (MA LPC NCC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:SURUBARU
Suffix:
Gender:F
Credentials:MA LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5507
Mailing Address - Country:US
Mailing Address - Phone:717-602-5065
Mailing Address - Fax:
Practice Address - Street 1:2106 ASPEN DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5507
Practice Address - Country:US
Practice Address - Phone:717-602-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC018006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty