Provider Demographics
NPI:1588178388
Name:LANCASTER PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:LANCASTER PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LEONOR
Authorized Official - Last Name:CABOULI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-475-7263
Mailing Address - Street 1:10 N MARKET ST UNIT 404
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3850
Mailing Address - Country:US
Mailing Address - Phone:717-399-3230
Mailing Address - Fax:
Practice Address - Street 1:313 W LIBERTY ST STE 223
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2722
Practice Address - Country:US
Practice Address - Phone:717-475-7263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty