Provider Demographics
NPI:1922146067
Name:O'CONNELL, SUSAN B (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:B
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 ROMONA RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2122
Mailing Address - Country:US
Mailing Address - Phone:847-256-6196
Mailing Address - Fax:847-256-6196
Practice Address - Street 1:527 ROMONA RD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2122
Practice Address - Country:US
Practice Address - Phone:847-256-6196
Practice Address - Fax:847-256-6196
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional