Healthcare Provider Details

I. General information

NPI: 1205266103
Provider Name (Legal Business Name): RONNIE ZUESSMAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 08/14/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A T AUGUSTA MILITARY MEDICAL CENTER 9600 DEWITT LOOP
FORT BELVOIR VA
22060
US

IV. Provider business mailing address

PO BOX 4523
FAIRFAX VA
22038-4523
US

V. Phone/Fax

Practice location:
  • Phone: 347-277-1135
  • Fax:
Mailing address:
  • Phone: 347-277-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number070100 6143
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number071700 1344
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005276
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: