Provider Demographics
NPI:1942418157
Name:SUDE, MICHAEL EVAN (PHD MFT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EVAN
Last Name:SUDE
Suffix:
Gender:M
Credentials:PHD MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2136
Mailing Address - Country:US
Mailing Address - Phone:315-445-0820
Mailing Address - Fax:315-445-0859
Practice Address - Street 1:4101 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-2136
Practice Address - Country:US
Practice Address - Phone:315-445-0820
Practice Address - Fax:315-445-0859
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP54396106H00000X
NY718106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist