Provider Demographics
NPI:1659161370
Name:SUSMAN, NATHAN (LGSW)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:SUSMAN
Suffix:
Gender:X
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2893 KNOX AVE S APT 216
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1859
Mailing Address - Country:US
Mailing Address - Phone:847-917-8780
Mailing Address - Fax:
Practice Address - Street 1:7030 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1370
Practice Address - Country:US
Practice Address - Phone:763-412-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN339971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical