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General NPI Number Information
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NPI Number | 1922385616
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Entity Type | Organization
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Legal Business Name | ROBERT J SUSIN PC
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 521 S LA GRANGE RD SUITE 209
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City | LA GRANGE
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State | IL
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Zip | 60525-6700
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Country | US
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Telephone | 708-822-7437
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Fax |
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Provider Business Mailing Address
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Address Line | 521 S LA GRANGE RD STE 209
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City | LA GRANGE
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State | IL
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Zip | 60525-6700
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Country | US
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Telephone | 702-822-7437
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Fax | 708-354-7438
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Authorized Official
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Title or Position | LCSW
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Name | MR. ROBERT J SUSIN
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Credential |
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Telephone | 708-822-7437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149005102
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License Number State | IL
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