1295965895 NPI number — SUZANNE CAROL HASTIE MA,BC-DMT,NCC,LPC

Table of content: SUZANNE CAROL HASTIE MA,BC-DMT,NCC,LPC (NPI 1295965895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295965895 NPI number — SUZANNE CAROL HASTIE MA,BC-DMT,NCC,LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASTIE
Provider First Name:
SUZANNE
Provider Middle Name:
CAROL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA,BC-DMT,NCC,LPC
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:
1295965895
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1804 W WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104-4144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-221-8586
Provider Business Mailing Address Fax Number:
484-221-8586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
628 TWIN PONDS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREINIGSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18031-1843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-417-0831
Provider Business Practice Location Address Fax Number:
484-221-8586
Provider Enumeration Date:
07/17/2009

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: 101YP2500X , with the licence number:  PC002827 , 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)





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