Provider Demographics
NPI:1104835263
Name:EICHMAN-PARCELL, SUSAN LYNNE (MA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNNE
Last Name:EICHMAN-PARCELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 W. NORTHSHORE AVENUE
Mailing Address - Street 2:2N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-5636
Mailing Address - Country:US
Mailing Address - Phone:312-259-9574
Mailing Address - Fax:773-296-3226
Practice Address - Street 1:1331 W NORTH SHORE AVE
Practice Address - Street 2:2N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-4766
Practice Address - Country:US
Practice Address - Phone:312-259-9574
Practice Address - Fax:773-296-3226
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL326165OtherMANAGED HEALTHCARENETWORK
IL493819000OtherMAGELLANBEHAVIORALHEALTH
IL741469000OtherMAGELLANBEHAVIORALHEALTH
IL276614OtherMANAGED HEALTHCARENETWORK