Provider Demographics
NPI:1851413611
Name:CAIN, SUSAN BUIVIDAS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BUIVIDAS
Last Name:CAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:BUIVIDAS
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1615 STODDARD AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3336
Mailing Address - Country:US
Mailing Address - Phone:630-510-9880
Mailing Address - Fax:
Practice Address - Street 1:1195 SUMMERHILL DR
Practice Address - Street 2:SUITE S500
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3160
Practice Address - Country:US
Practice Address - Phone:630-971-5074
Practice Address - Fax:630-971-5076
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
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