Provider Demographics
NPI:1154591030
Name:SUSSMAN, CRAIG (FNP-C,PMHNP)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:FNP-C,PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OLD ROAD TO NINE ACRE CORNER
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4141
Mailing Address - Country:US
Mailing Address - Phone:978-369-1113
Mailing Address - Fax:978-369-0908
Practice Address - Street 1:111 OLD ROAD TO NINE ACRE CORNER
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4141
Practice Address - Country:US
Practice Address - Phone:978-369-1113
Practice Address - Fax:978-369-0908
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN238050363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA238050OtherLICENSE