Provider Demographics
NPI:1144770884
Name:JESSE J. SUH, PSY.D. LLC
Entity Type:Organization
Organization Name:JESSE J. SUH, PSY.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:JONG-SHIK
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:215-207-9373
Mailing Address - Street 1:1601 WALNUT ST STE 1128
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2913
Mailing Address - Country:US
Mailing Address - Phone:215-207-9373
Mailing Address - Fax:
Practice Address - Street 1:1601 WALNUT ST STE 1128
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2913
Practice Address - Country:US
Practice Address - Phone:215-207-9373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016534103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty