Provider Demographics
NPI:1700864956
Name:SUSIN, ROBERT J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:SUSIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 S LA GRANGE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6700
Mailing Address - Country:US
Mailing Address - Phone:708-822-7437
Mailing Address - Fax:
Practice Address - Street 1:521 S LA GRANGE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6700
Practice Address - Country:US
Practice Address - Phone:708-822-7437
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical