Dr. Susan Samuel, Inc.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

071.008447

Legal business name

DR. SUSAN SAMUEL, INC.

Practice address

400 N McClurg CT
Suite 3304
Chicago, IL 60611-4323

Phone

(646) 397-2685

NPI assigned

Feb 28, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Susan Samuel, PSY.D.

Title

Licensed Psychologist

Phone

(630) 240-6197

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1362009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369180800000",
    "number": "1386984250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1812 BELLER RD",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605174606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N MCCLURG CT",
            "address_2": "SUITE 3304",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114323",
            "telephone_number": "646-397-2685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. SUSAN SAMUEL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-28",
        "last_updated": "2013-05-22",
        "status": "A",
        "authorized_official_last_name": "SAMUEL",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "630-240-6197",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": "071.008447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.