Provider Demographics
NPI:1639946155
Name:BICKLEY, SAUDIA S (LLC)
Entity type:Individual
Prefix:
First Name:SAUDIA
Middle Name:S
Last Name:BICKLEY
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2908
Mailing Address - Country:US
Mailing Address - Phone:610-508-9593
Mailing Address - Fax:
Practice Address - Street 1:1122 HARRISON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2908
Practice Address - Country:US
Practice Address - Phone:610-508-9593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015445101Y00000X, 101YP2500X
DEPC0011504101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor