Active NPI
Susan Longley
- Clinical Psychologist
- Oak Park, IL
National Provider Identifier
1376015396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.008872
- Practice address
- 851 Washington Blvd Apt A2
Oak Park, IL 60302-3851 - Phone
- (708) 955-3934
- NPI assigned
- Jan 2, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 018447-1 | NY | |
| Clinical Psychologist | 103TC0700X | 071.008872 | IL | Primary |
Addresses
Primary practice location
851 Washington Blvd Apt A2
Oak Park, IL 60302-3851
Mailing address
851 Washington Blvd Apt A2
Oak Park, IL 60302-3851
Phone (708) 955-3934
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.008872 | IL | MD | Clinical Psychologist |
| 018447-1 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546387200000",
"number": "1376015396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "851 WASHINGTON BLVD APT A2",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603023851",
"telephone_number": "708-955-3934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "851 WASHINGTON BLVD APT A2",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603023851",
"telephone_number": "708-955-3934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONGLEY",
"first_name": "SUSAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-02",
"last_updated": "2019-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "018447-1",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.008872",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.