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General NPI Number Information
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NPI Number | 1144770884
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Entity Type | Organization
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Legal Business Name | JESSE J. SUH, PSY.D. LLC
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 1601 WALNUT ST STE 1128
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2913
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Country | US
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Telephone | 215-207-9373
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 WALNUT ST STE 1128
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2913
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Country | US
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Telephone | 215-207-9373
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JESSE JONG-SHIK SUH
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Credential | PSY.D.
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Telephone | 215-207-9373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS016534
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License Number State | PA
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