Provider Demographics
NPI:1457575086
Name:MILLER, SUSAN M (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:MILLER
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 1:1222 W NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2519
Mailing Address - Country:US
Mailing Address - Phone:773-262-0233
Mailing Address - Fax:
Practice Address - Street 1:1165 N CLARK ST
Practice Address - Street 2:SUITE 413
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2702
Practice Address - Country:US
Practice Address - Phone:312-943-2155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
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