Provider Demographics
NPI:1245540640
Name:MATHEW, SUSAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 DONEGAL DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-8462
Mailing Address - Country:US
Mailing Address - Phone:630-240-6197
Mailing Address - Fax:
Practice Address - Street 1:2212 DONEGAL DR
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-8462
Practice Address - Country:US
Practice Address - Phone:630-240-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
071.008447103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist