Provider Demographics
NPI:1851681944
Name:SUD, PAYAL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAYAL
Middle Name:
Last Name:SUD
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:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60434-0596
Mailing Address - Country:US
Mailing Address - Phone:708-308-0453
Mailing Address - Fax:631-498-0453
Practice Address - Street 1:116 N CHICAGO ST STE 304
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-4212
Practice Address - Country:US
Practice Address - Phone:708-308-0453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490147731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001Medicaid