Provider Demographics
NPI:1518158666
Name:SUSAN M. DELLUTRI, LLC
Entity Type:Organization
Organization Name:SUSAN M. DELLUTRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DELLUTRI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LMFT, CSAC
Authorized Official - Phone:414-349-0340
Mailing Address - Street 1:4159 N STOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1743
Mailing Address - Country:US
Mailing Address - Phone:414-349-0340
Mailing Address - Fax:414-278-8299
Practice Address - Street 1:827 N CASS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3908
Practice Address - Country:US
Practice Address - Phone:414-278-7980
Practice Address - Fax:414-278-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health