Individual
DR. SUSANNA ANGELICA LACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
211 N MONROE ST, 2ND FLOOR, MEDIA, PA 19063-3019
(610) 891-9923
Mailing address
207 ENGLE DR, WALLINGFORD, PA 19086-6322
(610) 565-5885
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS008960
PA
Other
Enumeration date
01/20/2006
Last updated
07/08/2007
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