Mary Morag Sutherland, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071007653 Issued in IL

Practice address

1400 Renaissance Dr Ste 401
Park Ridge, IL 60068-1337

Phone

(847) 318-8200

Fax

(847) 318-9170

NPI assigned

Jun 3, 2010

Last updated

Jan 28, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Willow Wellness Center, PLLCGroup PAC ID 0941275267, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Willow Wellness Center, PLLC

  • Adult Mental Health Clinic/Center
  • Park Ridge, IL
  • NPI 1154437739

  Clinical

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674864000000",
    "number": "1255651162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 MAIN ST APT 305",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602022465",
            "telephone_number": "847-917-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 RENAISSANCE DR STE 401",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681337",
            "telephone_number": "847-318-8200",
            "fax_number": "847-318-9170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTHERLAND",
        "first_name": "MARY MORAG",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-03",
        "last_updated": "2023-01-28",
        "certification_date": "2023-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.007653",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071007653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sajid Sattar Suriya, MD
• Stephanie C Surkin, DPT
• Susan K Burrowes MD LLC
• Susana Salcedo MD LLC
• Joshua Thomas Sutherland
• Eric Swanson, DNP
• Linnea Rose Swanson, PHD
• Nancy H Swanson, MA, LPMT, MT-BC
• Kelly M Sweeney
• Mary Kate Sweeney, RN

• Clinical Psychologist in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.