Provider Demographics
NPI:1720715915
Name:BERTUGLIA, SUSAN HELENE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HELENE
Last Name:BERTUGLIA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S WAIOLA AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2263
Mailing Address - Country:US
Mailing Address - Phone:131-456-0733
Mailing Address - Fax:
Practice Address - Street 1:50 E WASHINGTON ST STE 301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2142
Practice Address - Country:US
Practice Address - Phone:312-252-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490209401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical