Organization
SUSQUEHANNA VALLEY PROFESSIONAL ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY HANS DERSTINE M.D. (MANAGING DIRECTOR)
(814) 867-9755
Entity
Organization
Contact information
Practice address
320 ROLLING RIDGE DR, SUITE 100, STATE COLLEGE, PA 16801-7641
(814) 867-0670
(814) 867-7616
Mailing address
320 ROLLING RIDGE DR, SUITE 100, STATE COLLEGE, PA 16801-7641
(814) 867-0670
(814) 867-7616
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02892000
CAPITAL BLUE CROSS
PA
Enumeration date
01/19/2006
Last updated
04/15/2015
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