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General NPI Number Information
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NPI Number | 1760297899
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Entity Type | Organization
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Legal Business Name | CRAIG SUSSMAN
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 196 SANDY POND RD
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City | LINCOLN
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State | MA
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Zip | 01773-2605
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Country | US
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Telephone | 508-816-1957
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Fax | 978-226-4887
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Provider Business Mailing Address
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Address Line | 196 SANDY POND RD
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City | LINCOLN
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State | MA
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Zip | 01773-2605
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Country | US
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Telephone | 508-816-1957
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Fax | 978-226-4887
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Authorized Official
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Title or Position | OWNER
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Name | MR. CRAIG SUSSMAN
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Credential | NP
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Telephone | 508-815-1957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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