1194903666 NPI number — DR. SUSAN MATOUR PSY.D.

Table of content: DR. SUSAN MATOUR PSY.D. (NPI 1194903666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194903666 NPI number — DR. SUSAN MATOUR PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATOUR
Provider First Name:
SUSAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194903666
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 LOCUST ST
Provider Second Line Business Mailing Address:
APT 15B
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19106-3934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-928-2019
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1503 LANSDOWNE AVE
Provider Second Line Business Practice Location Address:
3008
Provider Business Practice Location Address City Name:
DARBY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19023-1330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-237-4554
Provider Business Practice Location Address Fax Number:
610-237-2627
Provider Enumeration Date:
02/06/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PS017084 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)