Provider Demographics
NPI:1447558598
Name:SACK, SUSAN L (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:SACK
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 1:1430 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4628
Mailing Address - Country:US
Mailing Address - Phone:847-564-4655
Mailing Address - Fax:847-205-9363
Practice Address - Street 1:1544 SHERMER RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5347
Practice Address - Country:US
Practice Address - Phone:847-564-4655
Practice Address - Fax:847-205-9363
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0005711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical