Provider Demographics
NPI:1205825783
Name:SUSSER, HOWARD S (PHD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:S
Last Name:SUSSER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 HOOKER AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3631
Mailing Address - Country:US
Mailing Address - Phone:845-452-5498
Mailing Address - Fax:
Practice Address - Street 1:387 HOOKER AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-3631
Practice Address - Country:US
Practice Address - Phone:845-452-5498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7445103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00845682Medicaid
NY0004039OtherG.H.I.
NY781304OtherM.V.P.
NY781304OtherM.V.P.