Provider Demographics
NPI:1215588835
Name:SUSSMAN, TAMARA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:J
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 1:4005 48TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1028
Mailing Address - Country:US
Mailing Address - Phone:301-529-3664
Mailing Address - Fax:
Practice Address - Street 1:122 E 42ND ST FL 17
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10168-1799
Practice Address - Country:US
Practice Address - Phone:646-450-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023264103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical