Provider Demographics
NPI:1053696161
Name:FRALICK-BALL, SUSAN (PSYD, MSN)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:FRALICK-BALL
Suffix:
Gender:F
Credentials:PSYD, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 BARBY RD
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1717
Mailing Address - Country:US
Mailing Address - Phone:215-565-5803
Mailing Address - Fax:
Practice Address - Street 1:360 BARBY RD
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1717
Practice Address - Country:US
Practice Address - Phone:215-565-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015093103TC0700X
PAPS16513824103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist