Provider Demographics
NPI:1174803365
Name:WESNOSKI, SUSAN A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:WESNOSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104.5 FORREST AVENUE
Mailing Address - Street 2:SUITE 27 -THE HOLLY BUILDING
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072
Mailing Address - Country:US
Mailing Address - Phone:161-066-4252
Mailing Address - Fax:
Practice Address - Street 1:104.5 FORREST AVENUE
Practice Address - Street 2:SUITE 27- THE HOLLY BUILDING
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2215
Practice Address - Country:US
Practice Address - Phone:610-664-2524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0172611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical