Healthcare Provider Details

I. General information

NPI: 1194161398
Provider Name (Legal Business Name): SUSAN NARDELLA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST STE 12
LUNENBURG MA
01462-1423
US

IV. Provider business mailing address

1 MAIN ST STE 12
LUNENBURG MA
01462-1423
US

V. Phone/Fax

Practice location:
  • Phone: 351-356-3283
  • Fax: 351-356-3283
Mailing address:
  • Phone: 351-356-3283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY5000485
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS017378
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019973
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: