Provider Demographics
NPI:1164168274
Name:DANISH, SUSANNE (PHD)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:DANISH
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 1:1800 MENDON RD STE E-548
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4391
Mailing Address - Country:US
Mailing Address - Phone:401-206-0187
Mailing Address - Fax:
Practice Address - Street 1:2 LYN COURT
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-0286
Practice Address - Country:US
Practice Address - Phone:401-206-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01293103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical