Provider Demographics
NPI:1023215043
Name:SUSSMAN, LYNN MERLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:MERLE
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 ROCK RIMMON RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-1210
Mailing Address - Country:US
Mailing Address - Phone:203-595-9540
Mailing Address - Fax:203-329-7442
Practice Address - Street 1:1173 ROCK RIMMON RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-1210
Practice Address - Country:US
Practice Address - Phone:203-595-9540
Practice Address - Fax:203-329-7442
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002767103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling