Provider Demographics
NPI:1861672834
Name:MITZNER, GEORGE BADER (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BADER
Last Name:MITZNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 INDEPENDENCE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5177
Mailing Address - Country:US
Mailing Address - Phone:202-630-9382
Mailing Address - Fax:
Practice Address - Street 1:672 INDEPENDENCE PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5177
Practice Address - Country:US
Practice Address - Phone:202-630-9382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007246103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical