Provider Demographics
NPI:1134278708
Name:WEITZMAN, SUSAN (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:WEITZMAN
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E WASHINGTON ST
Mailing Address - Street 2:SUITE #2005
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1708
Mailing Address - Country:US
Mailing Address - Phone:312-444-1777
Mailing Address - Fax:847-883-8834
Practice Address - Street 1:25 E WASHINGTON ST
Practice Address - Street 2:SUITE #2005
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1708
Practice Address - Country:US
Practice Address - Phone:312-444-1777
Practice Address - Fax:847-883-8834
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0007791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
24149OtherCIGNA PROVIDER NUMBER
IL1671603OtherBLUECROSS PROVIDER NUMBER
152632000OtherMAGELLAN PROVIDER NUMBER