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NPI Code Detail

MEDICARE: MISS BARBARA CAROL SUCH PSY.D.

MEDICARE: MISS BARBARA CAROL SUCH PSY.D.
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
1103TC0700XClinical Psychologist071.005418IL

General Provider Information

NPI Number : 1518088533
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS BARBARA CAROL SUCH PSY.D.
Provider Business Mailing Address
First Line : 10901 WINDSOR DR
Second Line :
City : WESTCHESTER
State : IL
Zip : 60154-4942
Country : US
Telephone Number : 708-492-1272
Fax Number :
Provider Business Practice Location Address
First Line : 5341 W CERMAK RD
Second Line :
City : CICERO
State : IL
Zip : 60804-2817
Country : US
Telephone Number : 708-656-6430
Fax Number : 708-656-6591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2007
Last Update Date : 07/08/2007

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