Provider Demographics
NPI:1598512105
Name:MISTLER, SUSAN DIANE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DIANE
Last Name:MISTLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3128
Mailing Address - Country:US
Mailing Address - Phone:413-801-1068
Mailing Address - Fax:
Practice Address - Street 1:23 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3128
Practice Address - Country:US
Practice Address - Phone:413-801-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY7220103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist