Susan Stanton Douglas, M.D.
Individual provider Active NPI Child & Adolescent Psychiatry Physician · Monessen, PA
NPI 1043411341 · NPPES record last updated Mar 18, 2016
Key facts
- NPI
- 1043411341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Child & Adolescent Psychiatry Physician 2084P0804X
- License
- MD429498 (PA)
- Practice address
- 2 Eastgate Ave
Monessen, PA 15062-1393 - Phone
- (724) 684-6489
- Fax
- (724) 684-7116
- NPI assigned
- May 31, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD429498 | PA | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Behavioral Care, Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD429498 | PA | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | MD429498 | PA | Yes |
Addresses
Primary practice location
2 Eastgate Ave
Monessen, PA 15062-1393
Mailing address
2 Eastgate Ave
Monessen, PA 15062-1393
Phone (724) 684-6489
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023068350001 | Medicaid | PA |
Other providers in Monessen, PA
- Scott Anthony Cook
- Darlene Covol
- Donna Marie Dalfonso
- Dana Marie Defonso
- Destine Embrace Home Care LLC
- Dragan Chiropractic PLLC
- Douglas William Dragan
- Vanessa Lana Drew-Branch
- Epoch Sleep Consulting, LLC
- Tawni Marie Feeney
All providers in Monessen, PA · Child & Adolescent Psychiatry Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.