Provider Demographics
NPI:1205000569
Name:LYNN M. SUSSMAN, PH.D. LLC
Entity Type:Organization
Organization Name:LYNN M. SUSSMAN, PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:MERLE
Authorized Official - Last Name:SUSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-595-9540
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002767103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty