Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 048-0000730 | VT |
N | 103T00000X | Psychologist | 048-0000730 | VT |
Y | 102L00000X | Psychologist | PS00939 | RI |
Y | 103T00000X | Psychologist | PS00939 | RI |
N | 103TA0700X | Adult Development & Aging Psychologist | 048-0000730 | VT |
N | 103TA0700X | Adult Development & Aging Psychologist | PS00939 | RI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 048-0000730 | VT |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS00939 | RI |
N | 103G00000X | Clinical Psychologist | 048-0000730 | VT |
N | 103TC0700X | Clinical Psychologist | 048-0000730 | VT |
N | 103G00000X | Clinical Psychologist | PS00939 | RI |
N | 103TC0700X | Clinical Psychologist | PS00939 | RI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 048-0000730 | VT |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PS00939 | RI |
NPI | 1073731337 |
---|---|
Provider Name | Susan L Culbert |
First Address | Cranston, RI 02920-5126 |
Second Address | Warwick, RI 02886-1131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048-0000730 | LICENSED PSYCHOLOGIST (01) | VT |
PS00939 | LICENSED PSYCHOLOGIST (01) | RI |