Healthcare Provider Details

I. General information

NPI: 1306811682
Provider Name (Legal Business Name): SUSAN C BORRELLI LCPC,LMFT,CMADC,MPS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 N OSCEOLA AVE
CHICAGO IL
60631-4353
US

IV. Provider business mailing address

7200 N OSCEOLA AVE
CHICAGO IL
60631-4353
US

V. Phone/Fax

Practice location:
  • Phone: 773-763-4999
  • Fax: 773-763-0449
Mailing address:
  • Phone: 773-763-4999
  • Fax: 773-763-0449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: