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NPI Code Detail

MEDICARE: LYNN M. SUSSMAN, PH.D. LLC

MEDICARE: LYNN M. SUSSMAN, PH.D. LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling Psychologist002767CT

General Provider Information

NPI Number : 1205000569
Entity Type Code : Organization
Provider Name (Legal Business Name) : LYNN M. SUSSMAN, PH.D. LLC
Provider Business Mailing Address
First Line : 1173 ROCK RIMMON RD
Second Line :
City : STAMFORD
State : CT
Zip : 06903-1210
Country : US
Telephone Number : 203-517-8816
Fax Number :
Provider Business Practice Location Address
First Line : 1173 ROCK RIMMON RD
Second Line :
City : STAMFORD
State : CT
Zip : 06903-1210
Country : US
Telephone Number : 203-517-8816
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : LYNN MERLE SUSSMAN
Credential :
Telephone Number : 203-517-8816
Provider Enumeration Date : 04/17/2008
Last Update Date : 12/09/2025

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