Basic Information
| Provider Information | |||||||||
| NPI: | 1316974991 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HYMAN | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | PHD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 MARKET ST | ||||||||
| Address2: | 24TH FLOOR WEST TOWER | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191022100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152553529 | ||||||||
| FaxNumber: | 2158322213 | ||||||||
| Practice Location | |||||||||
| Address1: | 4641 ROOSEVELT BLVD | ||||||||
| Address2: | SUITE C229 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191242343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158314811 | ||||||||
| FaxNumber: | 2158312603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS009068L | PA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.