Provider Demographics
NPI:1568646123
Name:SUSSMAN, BARRY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 OAKRIDGE D
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1958
Mailing Address - Country:US
Mailing Address - Phone:561-376-4299
Mailing Address - Fax:561-431-5939
Practice Address - Street 1:1021 OAKRIDGE D
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1958
Practice Address - Country:US
Practice Address - Phone:561-376-4299
Practice Address - Fax:561-431-5939
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4977103TB0200X, 103TF0000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59454AOtherMEDICARE PTAN