Healthcare Provider Details

I. General information

NPI: 1720914872
Provider Name (Legal Business Name): SARA SUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-1834
US

IV. Provider business mailing address

418 KINGS PARK DRIVE EXT APT D
LIVERPOOL NY
13090-2776
US

V. Phone/Fax

Practice location:
  • Phone: 314-464-3149
  • Fax:
Mailing address:
  • Phone: 314-302-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: