Individual
SUZANNE DOMZALSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST
Contact information
Practice address
1125 WESTBRANCH HWY, WINFIELD, PA 17889-9253
(570) 524-0978
(570) 524-0880
Mailing address
1125 WESTBRANCH HWY, WINFIELD, PA 17889-9253
(570) 524-0978
(570) 524-0880
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS007245L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02157701
CAP (CBC)
PA
01
—
850349
BLUE SHIELD
PA
Enumeration date
01/08/2007
Last updated
07/08/2007
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