Provider Demographics
NPI:1881798239
Name:HOCHSTEDLER, SUSAN FORMAN (RN ,LADC 1)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:FORMAN
Last Name:HOCHSTEDLER
Suffix:
Gender:F
Credentials:RN ,LADC 1
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Mailing Address - Street 1:39 MIDDLE ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2755
Mailing Address - Country:US
Mailing Address - Phone:978-463-8724
Mailing Address - Fax:
Practice Address - Street 1:298 WASHINGTON ST.
Practice Address - Street 2:THE DISCOVER PROGRAM
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930
Practice Address - Country:US
Practice Address - Phone:978-283-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA719101YA0400X
MA213360163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered163W00000XNursing Service ProvidersRegistered Nurse