Provider Demographics
NPI:1487844569
Name:ZEICHNER, SUSAN HALE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HALE
Last Name:ZEICHNER
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 1:68 JOSEPHINE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2207
Mailing Address - Country:US
Mailing Address - Phone:617-625-8797
Mailing Address - Fax:
Practice Address - Street 1:68 JOSEPHINE AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2207
Practice Address - Country:US
Practice Address - Phone:617-625-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9190103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist