Provider Demographics
NPI:1720675507
Name:HIGGINS, SUSANNA VIOLET (LBS)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:VIOLET
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 ROUTE 100 STE 110
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-2951
Mailing Address - Country:US
Mailing Address - Phone:610-395-6322
Mailing Address - Fax:
Practice Address - Street 1:2909 ROUTE 100 STE 110
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2951
Practice Address - Country:US
Practice Address - Phone:610-395-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH005126106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician