| Susquehanna Psychological Services, Llc | |
|
20 Clearfield Street Elizabethville PA 17023-6603 | |
| (717) 362-8900 | |
| (717) 362-8910 |
| Full Name | Susquehanna Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 20 Clearfield Street, Elizabethville, Pennsylvania |
| Authorized Official Name and Position | Cynthia C Stauffer (PRESIDENT) |
| Authorized Official Contact | 7173628900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Susquehanna Psychological Services, Llc Po Box 739 Elizabethville PA 17023-0739 Ph: (717) 362-8900 | Susquehanna Psychological Services, Llc 20 Clearfield Street Elizabethville PA 17023-6603 Ph: (717) 362-8900 |
| NPI Number | 1114392552 |
|---|---|
| Provider Enumeration Date | 12/10/2015 |
| Last Update Date | 05/17/2021 |
| Certification Date | 04/26/2021 |
| Medicare PECOS PAC ID | 4486062437 |
|---|---|
| Medicare Enrollment ID | O20210413000698 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114392552 | NPI | - | NPPES |
| 0016838420002 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | P5006799L (Pennsylvania) | Primary |
| Provider Name | Cynthia C Stauffer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659494508 PECOS PAC ID: 6103138771 Enrollment ID: I20210413000814 |
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