Provider Demographics
NPI:1447332440
Name:SUSSEL, ANDREA (MSS)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SUSSEL
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 MAPLESHADE RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1820
Mailing Address - Country:US
Mailing Address - Phone:215-581-9142
Mailing Address - Fax:215-581-3827
Practice Address - Street 1:4200 MONUMENT ROAD
Practice Address - Street 2:BELMONT CENTER
Practice Address - City:PHILAELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131
Practice Address - Country:US
Practice Address - Phone:215-581-9142
Practice Address - Fax:215-581-3827
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0148641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical