Provider Demographics
NPI:1679686786
Name:SUSSMAN, LISA MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MICHELLE
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 S COOKS BRIDGE RD
Mailing Address - Street 2:SUITE 2-3
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2524
Mailing Address - Country:US
Mailing Address - Phone:732-994-7855
Mailing Address - Fax:732-242-6688
Practice Address - Street 1:27 S COOKS BRIDGE RD
Practice Address - Street 2:SUITE 2-3
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2524
Practice Address - Country:US
Practice Address - Phone:732-994-7855
Practice Address - Fax:732-242-6688
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100423600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist