DR. SUSANNA ANGELICA LACK (NPI# 1255311718) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255311718 |
| Entity Type | Individual |
| Full Name | DR. SUSANNA ANGELICA LACK |
| Credential | PSY.D. |
| Practice Address |
211 N Monroe St 2nd Floor Media PA 19063-3019 |
| Mailing Address |
207 Engle Dr Wallingford PA 19086-6322 |
| Practice Telephone | 6108919923 |
| Mailing Telephone | 6105655885 |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PS008960 | PA | Behavioral Health & Social Service Providers |
| Street Address |
211 N MONROE ST 2ND FLOOR |
| City | MEDIA |
| State | PA |
| Zip Code | 19063-3019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689665051 | Kanta Diwan | General Practice | 211 N Monroe St, Media, PA 19063-3019 | 2005-11-03 |
| 1396864435 | Gary M Miller | Social Worker | 211 N Monroe St, Second Floor, Media, PA 19063-3019 | 2007-03-28 |
| 1659469864 | Diwan Associates | Psychologist | 211 N Monroe St, Media, PA 19063-3019 | 2006-10-11 |
| 1598863623 | Linda Handloff Cohen | Psychologist | 211 N Monroe St, Media, PA 19063-3019 | 2006-09-20 |
| 1356447908 | Carl Richard Shafto | Psychiatry & Neurology | 211 N Monroe St, Media, PA 19063-3019 | 2006-09-14 |
| 1457374100 | Robert John Mckenney | Psychologist | 211 N Monroe St, Media, PA 19063-3019 | 2006-07-25 |
| 1437112729 | V. Richard Roeder | Psychologist | 211 N Monroe St, 2nd. Fl., Media, PA 19063-3019 | 2006-04-09 |
| 1245203413 | Julia L. Mayer | Psychologist | 211 N Monroe St, Second Floor, Media, PA 19063-3019 | 2006-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538766837 | Kimberly Ann Martyn | Nurse Practitioner | 168 W Baltimore Pike, Media, PA 19063 | 2020-10-08 |
| 1366060220 | Yinka Read | Clinical Neuropsychologist | 1088 W. Baltimore Pike, Healthcare II, Suite 2205, Media, PA 19063 | 2020-07-08 |
| 1306304522 | Caroline Dickerson | Speech-Language Pathologist | 510 Williamson Cir, Media, PA 19063 | 2019-03-06 |
| 1528544178 | Dayeon Cho | Nurse Practitioner | 1400 North Providence Road, Suite 1020, Rose Tree Corporate Center, Building 2, Media, PA 19063 | 2018-07-17 |
| 1235621400 | Joseph Savukinas | Registered Nurse | Mirmont Treatment Center, 100 Yearsley Mill Rd, Media, PA 19063 | 2018-06-04 |
| 1003331281 | Accredited Environmental Technologies, Inc. | Contractor | 28 N. Pennell Road, Media, PA 19063 | 2017-08-08 |
| 1538684220 | Holcomb Associates Inc. | Clinic/Center | 126 East Baltimore Pike, Gayley Square, Media, PA 19063 | 2017-08-03 |
| 1619498334 | Bryan Allen Mizell | Specialist/Technologist | 324 Crestview Circle, Media, PA 19063 | 2017-07-03 |
| 1427597970 | Grow Now Therapy Services LLC. | Speech-Language Pathologist | 600 N Jackson Street, Media, PA 19063 | 2017-02-16 |
| 1720520216 | Kathryn Rauch | Counselor | 107 Chesley Drive Unit #5, Media, PA 19063 | 2016-11-15 |
| Find all providers in zip 19063 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831658376 | Dragonfly Psychological Associates | Psychologist | 600 N Jackson St Ste 306, Media, PA 19063-2530 | 2019-03-14 |
| 1609345107 | Christopher Bailey | Psychologist | 77 W Baltimore Pike Ste 100a, Media, PA 19063-5637 | 2018-11-14 |
| 1619322112 | Prospect Health Access Network, Inc. | Psychologist | 176 S Middletown Rd, Media, PA 19063-5255 | 2016-05-03 |
| 1801146089 | Irwin Farbman | Psychologist | 20 W Third St, Media, PA 19063-2646 | 2012-09-14 |
| 1215141254 | Renee Balthrop | Psychologist | 13 Horseshoe Dr, Media, PA 19063-4415 | 2007-05-09 |
| 1093851024 | Jane E Iannuzzelli | Psychologist | 331 W State St, Media, PA 19063-2615 | 2007-01-29 |
| 1194870253 | Anthony Frank Goldsmith | Psychologist | 42 E Front St, Media, PA 19063-2912 | 2007-01-25 |
| 1457402570 | Michele A. Hyman | Psychologist | 319 W Front St, 2nd Floor, Media, PA 19063-2340 | 2007-01-16 |
| 1033272216 | Elizabeth Dale Blair | Psychologist | 280 North Providence Road, Media, PA 19063 | 2006-12-18 |
| 1598841314 | Gregory Broughton Milbourne | Psychologist | 13 W Third St Fl 3, Media, PA 19063-2803 | 2006-10-27 |
| Find all providers in MEDIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.