Provider Demographics
NPI:1447321252
Name:ATKINS, SUSAN JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JEAN
Last Name:ATKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-3245
Mailing Address - Country:US
Mailing Address - Phone:717-396-1365
Mailing Address - Fax:717-396-1365
Practice Address - Street 1:255 BUTLER AVE
Practice Address - Street 2:201
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6308
Practice Address - Country:US
Practice Address - Phone:717-396-1365
Practice Address - Fax:717-396-1365
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006493L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA127082Medicare ID - Type Unspecified