MEDICARE: MS. SUSAN L DASCENZI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149012589	IL

General Provider Information

NPI Number	:	1316107303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN L DASCENZI LCSW

Provider Business Mailing Address
First Line	:	8700 W 95TH ST
Second Line	:	SUITE #2
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-2700
Country	:	US
Telephone Number	:	708-598-9010
Fax Number	:	708-598-9013

Provider Business Practice Location Address
First Line	:	8700 W 95TH ST
Second Line	:	SUITE #2
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-2700
Country	:	US
Telephone Number	:	708-598-9010
Fax Number	:	708-598-9013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	06/12/2008

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