Provider Demographics
NPI:1891784476
Name:SUSMAN, BRENDA N (LMFT)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:N
Last Name:SUSMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 BLACK RIVER DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5723
Mailing Address - Country:US
Mailing Address - Phone:505-934-4120
Mailing Address - Fax:505-867-3247
Practice Address - Street 1:301 GRACELAND DR SE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2778
Practice Address - Country:US
Practice Address - Phone:505-934-4120
Practice Address - Fax:505-867-3247
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM0498106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist