Basic Information
| Provider Information | |||||||||
| NPI: | 1841590528 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STUBER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20134 VALLEY FORGE CIR | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194061112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108789330 | ||||||||
| FaxNumber: | 2675521002 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 VALLEY FORGE CIR. | ||||||||
| Address2: | SUITE 134 | ||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108789330 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2010 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | PS016790 | PA | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | PS016790 | PA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.