Healthcare Provider Details
I. General information
NPI: 1801832126
Provider Name (Legal Business Name): SUSAN BULL MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/22/2006
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1407 WILLIAMS RD
YORK PA
17402-9000
US
IV. Provider business mailing address
601 MEMORY LN
YORK PA
17402-2231
US
V. Phone/Fax
- Phone: 717-851-6340
- Fax: 717-851-6349
- Phone: 717-851-1405
- Fax: 717-851-6969
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | PS005237L |
| License Number State | PA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TB0200X |
| Taxonomy | Cognitive & Behavioral Psychologist |
| License Number | PS005237L |
| License Number State | PA |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103TC0700X |
| Taxonomy | Clinical Psychologist |
| License Number | PS005237L |
| License Number State | PA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: