MEDICARE: SUSAN TORRES HARDING PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	071006626	IL

General Provider Information

NPI Number	:	1033946793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN TORRES HARDING PHD

Provider Business Mailing Address
First Line	:	6818 N LAKEWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-3716
Country	:	US
Telephone Number	:	773-490-8455
Fax Number	:

Provider Business Practice Location Address
First Line	:	6818 N LAKEWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-3716
Country	:	US
Telephone Number	:	773-490-8455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	09/17/2024

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