Provider Demographics
NPI:1942324165
Name:GASS, SUZANNE CARMEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:CARMEN
Last Name:GASS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SUZANNE
Other - Middle Name:CARMEN
Other - Last Name:GASS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:2539 HURD AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1205
Mailing Address - Country:US
Mailing Address - Phone:773-490-9643
Mailing Address - Fax:
Practice Address - Street 1:5100 N RAVENSWOOD AVE # 203
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1710
Practice Address - Country:US
Practice Address - Phone:773-490-9643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-010414101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health