Provider Demographics
NPI:1215148556
Name:SCHLESSINGER-MITA, ESTHER SUSAN (PHD)
Entity type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:SUSAN
Last Name:SCHLESSINGER-MITA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 DERWYDD LN
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-2008
Mailing Address - Country:US
Mailing Address - Phone:610-647-4102
Mailing Address - Fax:
Practice Address - Street 1:171 W LANCASTER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1775
Practice Address - Country:US
Practice Address - Phone:610-594-9808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008842L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA029624Medicare ID - Type Unspecified