Provider Demographics
NPI:1467540831
Name:SUCICH, JAMES THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THOMAS
Last Name:SUCICH
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 1:257 NEAL DOW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3135
Mailing Address - Country:US
Mailing Address - Phone:718-815-3901
Mailing Address - Fax:718-815-3901
Practice Address - Street 1:601 79TH ST
Practice Address - Street 2:SUITE 1G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3760
Practice Address - Country:US
Practice Address - Phone:718-833-3466
Practice Address - Fax:718-815-3901
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS11628-5BOtherWORKERS' COMPENSATION AUT
NYP52822Medicare UPIN
NYS11628-5BOtherWORKERS' COMPENSATION AUT