Healthcare Provider Details

I. General information

NPI: 1801613559
Provider Name (Legal Business Name): SUSAN A SCHAFFER LCSW, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SKOKIE BLVD STE 207
NORTHBROOK IL
60062-2818
US

IV. Provider business mailing address

3277 WESTERN AVE
HIGHLAND PARK IL
60035-1200
US

V. Phone/Fax

Practice location:
  • Phone: 224-208-5198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN A SCHAFFER
Title or Position: OWNER/PRESIDENT
Credential: LCSW
Phone: 847-217-6871