Provider Demographics
NPI:1306811682
Name:BORRELLI, SUSAN C (LCPC,LMFT,CMADC,MPS)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:BORRELLI
Suffix:
Gender:F
Credentials:LCPC,LMFT,CMADC,MPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 N OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-4353
Mailing Address - Country:US
Mailing Address - Phone:773-763-4999
Mailing Address - Fax:773-763-0449
Practice Address - Street 1:7200 N OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-4353
Practice Address - Country:US
Practice Address - Phone:773-763-4999
Practice Address - Fax:773-763-0449
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist