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General NPI Number Information
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NPI Number | 1508018847
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Entity Type | Organization
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Legal Business Name | BLOSSOMING FIGS PSYCHOLOGICAL SERVICES, LLC.
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Dates
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Enumeration Date | 10/17/2008
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 223 WASHINGTON ST IST FLOOR OFFICE
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-2862
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Country | US
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Telephone | 570-424-6734
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Fax | 570-424-6734
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Provider Business Mailing Address
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Address Line | PO BOX 957
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-4257
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Country | US
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Telephone | 570-424-6734
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Fax | 570-424-6734
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SUSSIE ESHUN
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Credential | PH.D.
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Telephone | 570-424-6734
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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 | PS015651
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License Number State | PA
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