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General NPI Number Information
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NPI Number | 1003047259
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Entity Type | Individual
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Provider Name | SUE EI PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 05/08/2010
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Provider Practice Location Address
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Address Line | 816 CENTRAL RD
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City | BLOOMSBURG
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State | PA
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Zip | 17815-8976
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Country | US
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Telephone | 570-387-1382
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Fax |
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Provider Business Mailing Address
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Address Line | 222 W 9TH ST
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City | BLOOMSBURG
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State | PA
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Zip | 17815-2506
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Country | US
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Telephone | 702-379-6277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS016760
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License Number State | PA
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