Provider Demographics
NPI:1457412629
Name:BORSTEIN, SUZANNE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:S
Last Name:BORSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 SOCKANOSSET CROSS ROAD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5558
Mailing Address - Country:US
Mailing Address - Phone:401-941-2159
Mailing Address - Fax:401-941-2159
Practice Address - Street 1:75 SOCKANOSSET CROSS ROAD
Practice Address - Street 2:SUITE 212
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5558
Practice Address - Country:US
Practice Address - Phone:401-941-2159
Practice Address - Fax:401-941-2159
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003397Medicaid
RI9003397Medicaid