Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 002767 | CT |
NPI | 1023215043 |
---|---|
Provider Name | Dr. Lynn Merle Sussman |
First Address | Stamford, CT 06903-1210 |
Second Address | Stamford, CT 06903-1210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 08/07/2007 |