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General NPI Number Information
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NPI Number | 1497411995
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Entity Type | Individual
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Provider Name | DANIEL S. SUSSMAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 7007 ROMAINE ST FL 6
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90038-2439
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Country | US
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Telephone | 310-356-9542
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 374
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City | SANTA MONICA
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State | CA
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Zip | 90406-0374
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Country | US
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Telephone | 310-890-5523
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 14202
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License Number State | CA
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