Healthcare Provider Details

I. General information

NPI: 1437595733
Provider Name (Legal Business Name): JOSHUA MICHAEL SUSSMAN M.A., M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 07/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 BROADWAY STE 610
OAKLAND CA
94612-2026
US

IV. Provider business mailing address

4511 TOLMAN HALL
BERKELEY CA
94720
US

V. Phone/Fax

Practice location:
  • Phone: 510-628-9065
  • Fax:
Mailing address:
  • Phone: 415-320-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: