Provider Demographics
NPI:1811754807
Name:SUSSMAN, EVE MARIE FARIS (LP)
Entity type:Individual
Prefix:DR
First Name:EVE
Middle Name:MARIE FARIS
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:MARIE
Other - Last Name:FARIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2004 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1750
Mailing Address - Country:US
Mailing Address - Phone:952-200-6920
Mailing Address - Fax:
Practice Address - Street 1:2004 RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1750
Practice Address - Country:US
Practice Address - Phone:651-690-6805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6726103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist