Provider Demographics
NPI:1134132541
Name:GIBSON, SUZANNE SITES (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:SITES
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4205
Mailing Address - Country:US
Mailing Address - Phone:847-304-1062
Mailing Address - Fax:847-382-7727
Practice Address - Street 1:201 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-4205
Practice Address - Country:US
Practice Address - Phone:847-304-1062
Practice Address - Fax:847-382-7727
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical