Provider Demographics
NPI:1699804518
Name:MATTIES, SUSAN (PSYD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MATTIES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 CHARTER LN
Mailing Address - Street 2:SUITE 118
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6736
Mailing Address - Country:US
Mailing Address - Phone:717-272-6621
Mailing Address - Fax:717-290-1104
Practice Address - Street 1:1861 CHARTER LN
Practice Address - Street 2:SUITE 118
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6736
Practice Address - Country:US
Practice Address - Phone:717-272-6621
Practice Address - Fax:717-290-1104
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016541103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical