Provider Information for 1740418342
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MARK CHUSTZ LCSW
Sex: Male
NPI: 1740418342
Last Updated: 2020-09-16
Certification Date: 2020-09-16
Certification Date: 2020-09-16
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1740418342 | ||||||||
| Enumeration Date | 2009-06-23 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 77 MILL ST WESTFIELD, MA 01085-4598 United States Phone: 504-920-7374 | Fax: | ||||||||
| Primary Practice Address | 5621 HILLTOP CIR SAINT FRANCISVILLE, LA 70775-5620 United States Phone: 225-931-6814 | Fax: | ||||||||
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