Provider Demographics
NPI:1487385035
Name:PACKARD, SUSAN ELIZABETH (LPC, PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:PACKARD
Suffix:
Gender:F
Credentials:LPC, PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1602
Mailing Address - Country:US
Mailing Address - Phone:412-741-7430
Mailing Address - Fax:
Practice Address - Street 1:250 W 7TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1602
Practice Address - Country:US
Practice Address - Phone:814-456-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000398101YP2500X
PAPS008210L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional