Basic Information
| Provider Information | |||||||||
| NPI: | 1801832126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BULL | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | MS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NEFF | ||||||||
| OtherFirstName: | SUSAN | ||||||||
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| OtherCredential: | MS | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516349 | ||||||||
| Practice Location | |||||||||
| Address1: | 3550 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174028626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178516340 | ||||||||
| FaxNumber: | 7178516349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 06/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS005237L | PA | N | Behavioral Health & Social Service Providers | Psychologist | 103TB0200X | PS005237L | PA | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | PS005237L | PA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 01097101 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 3109677 | 01 | PA | MAMSI | OTHER | 2173377 | 01 | PA | CIGNA BEHAVIORAL HEALTH | OTHER | 365485 | 01 | PA | VALUE OPTIONS | OTHER | 184110 | 01 | PA | PA BLUE SHIELD | OTHER | 227688000 | 01 | PA | MAGELLAN | OTHER |