Provider Demographics
NPI:1851674378
Name:SUBURBAN BEHAVIORAL HEALTH INC
Entity type:Organization
Organization Name:SUBURBAN BEHAVIORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLEWALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:331-643-0559
Mailing Address - Street 1:1 S 443 SUMMIT AVE
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3973
Mailing Address - Country:US
Mailing Address - Phone:630-613-9800
Mailing Address - Fax:630-613-9865
Practice Address - Street 1:263 BALMORAL CT
Practice Address - Street 2:
Practice Address - City:GLENDALE HTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1306
Practice Address - Country:US
Practice Address - Phone:331-643-0559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361214442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty