Provider Demographics
NPI:1497411995
Name:SUSSMAN, DANIEL S (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:SUSSMAN
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:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90406-0374
Mailing Address - Country:US
Mailing Address - Phone:310-890-5523
Mailing Address - Fax:
Practice Address - Street 1:7007 ROMAINE ST FL 6
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90038-2439
Practice Address - Country:US
Practice Address - Phone:310-356-9542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14202103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical