Healthcare Provider Details

I. General information

NPI: 1700516812
Provider Name (Legal Business Name): LAUREN SUCHY MARZINELLI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 2025
CHICAGO IL
60611-2927
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 2025
CHICAGO IL
60611-2927
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0596
  • Fax: 312-695-5232
Mailing address:
  • Phone: 312-695-0596
  • Fax: 312-695-5232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.023631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: