MEDICARE: DR. BARRY SUSSMAN PSY.D.

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
1	103TB0200X	Cognitive & Behavioral Psychologist	PY4977	FL
2	103TF0000X	Family Psychologist	PY4977	FL
3	103TC0700X	Clinical Psychologist	PY4977	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	59454A	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1568646123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY SUSSMAN PSY.D.

Provider Business Mailing Address
First Line	:	1021 OAKRIDGE D
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-1958
Country	:	US
Telephone Number	:	561-376-4299
Fax Number	:	561-431-5939

Provider Business Practice Location Address
First Line	:	1021 OAKRIDGE D
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-1958
Country	:	US
Telephone Number	:	561-376-4299
Fax Number	:	561-431-5939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	04/25/2020

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