Provider Demographics
NPI:1508102534
Name:SUSSMAN, MEIRA (NCSP)
Entity Type:Individual
Prefix:MRS
First Name:MEIRA
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 MARLBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4301
Mailing Address - Country:US
Mailing Address - Phone:718-284-3110
Mailing Address - Fax:
Practice Address - Street 1:83 MARLBOROUGH RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4301
Practice Address - Country:US
Practice Address - Phone:718-284-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool