Provider Demographics
NPI:1568473932
Name:ROBISON, SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ROBISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-1901
Mailing Address - Country:US
Mailing Address - Phone:630-516-0776
Mailing Address - Fax:847-591-8395
Practice Address - Street 1:352 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-1901
Practice Address - Country:US
Practice Address - Phone:630-516-0776
Practice Address - Fax:847-593-8395
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490078821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
363045007OtherTAX ID
IL208850Medicare ID - Type UnspecifiedGROUP#