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General NPI Number Information
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NPI Number | 1003093261
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Entity Type | Individual
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Provider Name | DEVA SUCKERMAN LCPC
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Gender | Female
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 140 HARRISON ST #GE
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City | OAK PARK
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State | IL
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Zip | 60304-1600
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Country | US
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Telephone | 312-399-7143
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Fax | 312-492-9058
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Provider Business Mailing Address
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Address Line | 2418 W BLOOMINGDALE AVE APT 206
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City | CHICAGO
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State | IL
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Zip | 60647-4366
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Country | US
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Telephone | 312-399-7143
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180004444
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License Number State | IL
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