Provider Demographics
NPI:1831313055
Name:SUSSMAN, PAUL ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:SUSSMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2710 TERESITA STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-5255
Mailing Address - Country:US
Mailing Address - Phone:619-624-0430
Mailing Address - Fax:619-542-1344
Practice Address - Street 1:3101 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5802
Practice Address - Country:US
Practice Address - Phone:619-542-1335
Practice Address - Fax:619-542-1344
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13876103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical