Provider Demographics
NPI:1952372724
Name:PANITCH, SUSAN E (MA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:PANITCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 ROCKLAND RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1780
Mailing Address - Country:US
Mailing Address - Phone:847-615-9445
Mailing Address - Fax:847-735-0815
Practice Address - Street 1:655 ROCKLAND RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1782
Practice Address - Country:US
Practice Address - Phone:847-615-9445
Practice Address - Fax:847-735-0815
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4926888OtherBLUE CROSS BLUE SHIELD