Healthcare Provider Details

I. General information

NPI: 1366352429
Provider Name (Legal Business Name): SUSAN CARDONE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 W BYRON ST
CHICAGO IL
60641-2712
US

IV. Provider business mailing address

5300 S HYDE PARK BLVD APT 401
CHICAGO IL
60615-5717
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-7800
  • Fax:
Mailing address:
  • Phone: 872-463-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.041931
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: