Individual
DR. LEWIS R SUSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
BROOKE ARMY MEDICAL CENTER, 3551 ROGER BROOKE DRIVE, JBSA FORT SAM HOUSTON, TX 78234
(210) 539-8798
Mailing address
BROOKE ARMY MEDICAL CENTER, 3551 ROGER BROOKE DRIVE, JBSA FORT SAM HOUSTON, TX 78234
(210) 539-8798
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
997
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1004243
MEDICAID
VT
05
—
30422291
—
NH
Enumeration date
12/06/2006
Last updated
06/12/2020
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