Provider Demographics
NPI:1174693667
Name:DUMA, SUSAN J (PSYD, MPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:DUMA
Suffix:
Gender:F
Credentials:PSYD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 W MADISON ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2023
Mailing Address - Country:US
Mailing Address - Phone:773-599-9746
Mailing Address - Fax:
Practice Address - Street 1:1142 W MADISON ST
Practice Address - Street 2:SUITE 406
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2023
Practice Address - Country:US
Practice Address - Phone:773-599-9746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010030833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical