Provider Demographics
NPI:1720675507
Name:HIGGINS-BOYD, SUSANNA VIOLET (LBS)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:VIOLET
Last Name:HIGGINS-BOYD
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 GUYTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-6047
Mailing Address - Country:US
Mailing Address - Phone:610-390-5561
Mailing Address - Fax:
Practice Address - Street 1:2717 GUYTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-6047
Practice Address - Country:US
Practice Address - Phone:610-390-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH005126251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health