Provider Demographics
NPI:1376688291
Name:CAREY, SUZANNE BOGUE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:BOGUE
Last Name:CAREY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 N SANDBURG TER APT 309
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2206
Mailing Address - Country:US
Mailing Address - Phone:312-943-5694
Mailing Address - Fax:
Practice Address - Street 1:1 E DELAWARE PL
Practice Address - Street 2:SUITE 310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1449
Practice Address - Country:US
Practice Address - Phone:708-945-6358
Practice Address - Fax:312-943-8987
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional