Organization
SUSQUEHANNA VALLEY PROFESSIONAL ASSOCIATES, INC
Active
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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