Provider Demographics
NPI:1417962770
Name:STIEFEL, SUSANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:
Last Name:STIEFEL
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 1:37 TURTLE RUN RD
Mailing Address - Street 2:UNIT #21
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-3083
Mailing Address - Country:US
Mailing Address - Phone:207-395-4754
Mailing Address - Fax:
Practice Address - Street 1:TOGUS VA MEDICAL CENTER
Practice Address - Street 2:1 VA CENTER
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-621-7359
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS628103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist