Healthcare Provider Details

I. General information

NPI: 1518088533
Provider Name (Legal Business Name): BARBARA CAROL SUCH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5341 W CERMAK RD
CICERO IL
60804-2817
US

IV. Provider business mailing address

10901 WINDSOR DR
WESTCHESTER IL
60154-4942
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-6430
  • Fax: 708-656-6591
Mailing address:
  • Phone: 708-492-1272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.005418
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: