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General NPI Number Information
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NPI Number | 1386984250
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Entity Type | Organization
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Legal Business Name | DR. SUSAN SAMUEL, INC.
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 400 N MCCLURG CT SUITE 3304
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City | CHICAGO
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State | IL
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Zip | 60611-4323
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Country | US
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Telephone | 646-397-2685
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Fax |
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Provider Business Mailing Address
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Address Line | 1812 BELLER RD
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City | WOODRIDGE
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State | IL
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Zip | 60517-4606
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. SUSAN SAMUEL
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Credential | PSY.D.
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Telephone | 630-240-6197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071.008447
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License Number State |
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