Provider Demographics
NPI:1669498671
Name:NORMAN, SUZANNE M (PH D)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:NORMAN
Suffix:
Gender:F
Credentials:PH D
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 30264
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230
Mailing Address - Country:US
Mailing Address - Phone:513-233-3500
Mailing Address - Fax:513-233-3501
Practice Address - Street 1:4030 MT CARMEL TOBASCO RD
Practice Address - Street 2:SUITE 306D
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255
Practice Address - Country:US
Practice Address - Phone:513-233-3500
Practice Address - Fax:513-233-3501
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5372103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2506612Medicaid
OHCP30181Medicare PIN