Provider Demographics
NPI:1669465993
Name:SUSMAN, DAVID T (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:SUSMAN
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 1:1417 COPPERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1275
Mailing Address - Country:US
Mailing Address - Phone:859-224-0851
Mailing Address - Fax:
Practice Address - Street 1:275 E MAIN ST # 4W-F
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40621-1207
Practice Address - Country:US
Practice Address - Phone:502-782-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY842103TC0700X
KY129106103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical