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General NPI Number Information
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NPI Number | 1588014633
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Entity Type | Individual
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Provider Name | SUSAN M RAMIREZ PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 3412 S ILLINOIS AVE
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City | CARBONDALE
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State | IL
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Zip | 62903-8362
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Country | US
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Telephone | 618-305-0988
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 122
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City | CARTERVILLE
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State | IL
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Zip | 62918-0122
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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 |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY27983
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY27983
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071010852
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License Number State | IL
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