Provider Demographics
NPI:1316107303
Name:DASCENZI, SUSAN L (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:DASCENZI
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 1:8700 W 95TH ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-2700
Mailing Address - Country:US
Mailing Address - Phone:708-598-9010
Mailing Address - Fax:708-598-9013
Practice Address - Street 1:8700 W 95TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-2700
Practice Address - Country:US
Practice Address - Phone:708-598-9010
Practice Address - Fax:708-598-9013
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490125891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical