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General NPI Number Information
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NPI Number | 1255651162
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Entity Type | Individual
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Provider Name | MARY MORAG SUTHERLAND PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 01/28/2023
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Provider Practice Location Address
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Address Line | 1400 RENAISSANCE DR STE 401
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City | PARK RIDGE
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State | IL
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Zip | 60068-1337
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Country | US
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Telephone | 847-318-8200
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Fax | 847-318-9170
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Provider Business Mailing Address
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Address Line | 222 MAIN ST APT 305
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City | EVANSTON
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State | IL
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Zip | 60202-2465
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Country | US
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Telephone | 847-917-2951
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.007653
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071007653
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License Number State | IL
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