Individual provider Active NPI

Suzanne G Sall

  • Psychologist
  • Penn Valley, PA
National Provider Identifier
1386154698
Registry record updated Oct 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PS009142L Issued in PA
Practice address
1340 June LN
Penn Valley, PA 19072-1115
Phone
(610) 256-2530
NPI assigned
Oct 2, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PS009142L PA Primary

Addresses

Primary practice location

1340 June LN
Penn Valley, PA 19072-1115

Mailing address

1340 June LN
Penn Valley, PA 19072-1115
Phone (610) 256-2530

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191226000253 PA Practitioner - Clinical Psychologist 9032543129 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Senior Care Therapy of Pennsylvania, P.C. CurrentSince Nov 1, 2019 Accepting new patients
University of Penn-Medical Group CurrentSince Feb 1, 2021 Accepting new patients
University of Penn-Medical Group CurrentSince Feb 1, 2021 Accepting new patients

Locations

2719 Hollywood Blvd
Hollywood, FL 33020
Phone (954) 354-2555

3400 Civic Center Blvd
#2
Philadelphia, PA 19104
Phone (215) 615-0063

815 Chester Pike
Prospect Park, PA 19076
Phone (610) 586-6262

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506902400000",
    "number": "1386154698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 JUNE LN",
            "city": "PENN VALLEY",
            "state": "PA",
            "postal_code": "190721115",
            "telephone_number": "610-256-2530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 JUNE LN",
            "city": "PENN VALLEY",
            "state": "PA",
            "postal_code": "190721115",
            "telephone_number": "610-256-2530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALL",
        "first_name": "SUZANNE",
        "middle_name": "G",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-02",
        "last_updated": "2017-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS009142L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Penn Valley, PA

Sources for this page

Verify at the official NPI Registry.