Provider Demographics
NPI:1134696982
Name:WEINBERG, SUSANNAH ROSE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:ROSE
Last Name:WEINBERG
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1817
Mailing Address - Country:US
Mailing Address - Phone:708-837-8949
Mailing Address - Fax:
Practice Address - Street 1:1031 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1817
Practice Address - Country:US
Practice Address - Phone:708-837-8949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0191701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty