MEDICARE: SUSANNA VIOLET HIGGINS-BOYD LBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	BH005126	PA

General Provider Information

NPI Number	:	1720675507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNA VIOLET HIGGINS-BOYD LBS

Provider Business Mailing Address
First Line	:	2717 GUYTON ST
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-6047
Country	:	US
Telephone Number	:	610-390-5561
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 GUYTON ST
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-6047
Country	:	US
Telephone Number	:	610-390-5561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2020
Last Update Date	:	09/12/2025

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