Provider Demographics
NPI:1730249491
Name:CHANDLER, SUSAN KATHRYN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KATHRYN
Last Name:CHANDLER
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 1:41 OLD BRUNSWICK ROAD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032
Mailing Address - Country:US
Mailing Address - Phone:207-865-2958
Mailing Address - Fax:
Practice Address - Street 1:153-B PARK ROW
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-798-4609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECHMM6843Medicare ID - Type Unspecified