Provider Demographics
NPI:1922082668
Name:CABOULI, SUSAN L (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:CABOULI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 W LIBERTY ST STE 223
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2722
Mailing Address - Country:US
Mailing Address - Phone:717-475-7263
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:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006748L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA105771OtherBLUE SHIELD
R06095Medicare UPIN
PA105771Medicare ID - Type Unspecified