Provider Demographics
NPI:1619236031
Name:SCHAFFER, SUSAN A (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:SCHAFFER
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 1:601 SKOKIE BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2818
Mailing Address - Country:US
Mailing Address - Phone:847-217-6871
Mailing Address - Fax:224-306-2318
Practice Address - Street 1:601 SKOKIE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2818
Practice Address - Country:US
Practice Address - Phone:847-217-6871
Practice Address - Fax:224-306-2318
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490090221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical