Individual provider Active NPI

Paul David Shore-Suslowitz, ED.D.

  • Clinical Psychologist
  • Longmeadow, MA
National Provider Identifier
1871652156
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2521 Issued in MA
Practice address
171 Dwight Rd Ste 301a
Longmeadow, MA 01106-1700
Phone
(413) 575-6801
NPI assigned
Dec 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 2521 MA Primary

Addresses

Primary practice location

171 Dwight Rd Ste 301a
Longmeadow, MA 01106-1700

Mailing address

171 Dwight Rd Ste 301a
Longmeadow, MA 01106-1700
Phone (413) 575-6801

Other identifiers 1

IdentifierTypeStateIssuer
1859480MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111101000631 MA Practitioner - Clinical Psychologist 6709059066 Practice locations: East Longmeadow, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

270 Benton Dr
East Longmeadow, MA 01028-3119
Phone (413) 575-6801

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2521MAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Ubuntu Omoiyari Therapy Group PLLC CurrentSince Jul 22, 2025 Accepting new patients
Greater Springfield Counseling, PC Past Accepting new patients

Locations

171 Dwight Rd
Ste 301A
Longmeadow, MA 01106
Phone (413) 349-8115

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747872000000",
    "number": "1871652156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 DWIGHT RD STE 301A",
            "city": "LONGMEADOW",
            "state": "MA",
            "postal_code": "011061700",
            "telephone_number": "413-575-6801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 DWIGHT RD STE 301A",
            "city": "LONGMEADOW",
            "state": "MA",
            "postal_code": "011061700",
            "telephone_number": "413-575-6801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORE-SUSLOWITZ",
        "first_name": "PAUL",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "ED.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "2521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1859480",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmeadow, MA

Sources for this page

Verify at the official NPI Registry.