Provider Demographics
NPI:1376062570
Name:OCONNOR, SUSAN MARINA (LPC CADC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARINA
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:LPC CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 KING ARTHUR CT APT 13
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2245
Mailing Address - Country:US
Mailing Address - Phone:630-205-3935
Mailing Address - Fax:
Practice Address - Street 1:829 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8573
Practice Address - Country:US
Practice Address - Phone:815-725-7454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional