Individual
DR. LANA N. SUSSKIND-WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
9832 N HAYDEN RD, SUITE 106, SCOTTSDALE, AZ 85258-1298
(480) 945-3475
(480) 922-5569
Mailing address
7323 N 12TH AVE, PHOENIX, AZ 85021-8023
(602) 410-9011
(480) 922-5569
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
3842
AZ
103T00000X
Psychologist
3842
AZ
103TA0700X
Adult Development & Aging Psychologist
3842
AZ
103TB0200X
Cognitive & Behavioral Psychologist
3842
AZ
103TC0700X
Clinical Psychologist
3842
AZ
103TF0200X
Forensic Psychologist
3842
AZ
103TP2701X
Group Psychotherapy Psychologist
3842
AZ
103TR0400X
Rehabilitation Psychologist
3842
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z60229
MEDICARE GROUP PIN
AZ
Enumeration date
11/22/2006
Last updated
01/14/2008
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