Provider Demographics
NPI:1124358023
Name:LIPSHUTZ, SUSAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:LIPSHUTZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W ERIE ST STE 405
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6918
Mailing Address - Country:US
Mailing Address - Phone:312-787-7077
Mailing Address - Fax:708-445-0650
Practice Address - Street 1:430 W ERIE ST STE 405
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-6918
Practice Address - Country:US
Practice Address - Phone:312-787-7077
Practice Address - Fax:708-445-0650
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0016841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical