Provider Demographics
NPI:1699377929
Name:SUSAN M RICHARDSON, PSY D, LLC
Entity Type:Organization
Organization Name:SUSAN M RICHARDSON, PSY D, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:224-627-4908
Mailing Address - Street 1:65 E MONROE ST UNIT 4314
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-5737
Mailing Address - Country:US
Mailing Address - Phone:224-627-4908
Mailing Address - Fax:312-600-3880
Practice Address - Street 1:65 E MONROE ST UNIT 4314
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-5737
Practice Address - Country:US
Practice Address - Phone:224-627-4908
Practice Address - Fax:312-600-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty