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Individual

DR. BERNARDINE SUPPA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PSY D

Contact information

Practice address
16 LUZERNE AVE, WEST PITTSTON, PA 18643-2817
(570) 961-3361
(570) 961-3364
Mailing address
38 NORTH ST, COURTDALE, PA 18704-1713
(570) 288-2430

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS008862L
PA
103TC0700X
Clinical Psychologist
PS008862L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0017502200004
PA
Enumeration date
01/23/2007
Last updated
11/15/2023
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