Individual
SUSAN E DIETERICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
64 POST RD W, WESTPORT, CT 06880-4208
(203) 231-6188
Mailing address
64 POST RD W, WESTPORT, CT 06880-4208
(203) 231-6188
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
002826
CT
Other
Enumeration date
07/18/2006
Last updated
10/20/2016
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