Provider Demographics
NPI:1275631160
Name:MITCHELL, SUSAN ER (PSYD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ER
Last Name:MITCHELL
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 1:430 EXTON CMNS
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2451
Mailing Address - Country:US
Mailing Address - Phone:484-887-0312
Mailing Address - Fax:267-295-9905
Practice Address - Street 1:430 EXTON CMNS
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2451
Practice Address - Country:US
Practice Address - Phone:484-887-0312
Practice Address - Fax:267-295-9905
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009172L103T00000X
DEB10000660103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE202841OtherCOMPSYCH
DE202841OtherCOMPSYCH