Provider Demographics
NPI:1760297899
Name:CRAIG SUSSMAN
Entity type:Organization
Organization Name:CRAIG SUSSMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:508-815-1957
Mailing Address - Street 1:196 SANDY POND RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-2605
Mailing Address - Country:US
Mailing Address - Phone:508-816-1957
Mailing Address - Fax:978-226-4887
Practice Address - Street 1:196 SANDY POND RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MA
Practice Address - Zip Code:01773-2605
Practice Address - Country:US
Practice Address - Phone:508-816-1957
Practice Address - Fax:978-226-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No251B00000XAgenciesCase Management