Provider Demographics
NPI:1659398584
Name:FESSENDEN, SUZANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:FESSENDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3317
Mailing Address - Country:US
Mailing Address - Phone:631-673-3226
Mailing Address - Fax:631-673-3028
Practice Address - Street 1:17 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3317
Practice Address - Country:US
Practice Address - Phone:631-673-3226
Practice Address - Fax:631-673-3028
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014123103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
6883291OtherGHI
P2524066OtherOXFORD
NYV119VOtherEMPIRE BC/BS
7931185OtherAETNA
6883291OtherGHI