Provider Demographics
NPI:1437595733
Name:SUSSMAN, JOSHUA MICHAEL (MA, MED)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:MICHAEL
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 TOLMAN HALL
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720
Mailing Address - Country:US
Mailing Address - Phone:415-320-1579
Mailing Address - Fax:
Practice Address - Street 1:1440 BROADWAY STE 610
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2026
Practice Address - Country:US
Practice Address - Phone:510-628-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist