Vijayalakshmi Susarla, PH.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

071005075 Issued in IL

Practice address

2628 83Rd St
Darien, IL 60561-1661

Phone

(630) 246-6810

Fax

(630) 246-6809

NPI assigned

Aug 30, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 16, 2023 through Dec 16, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Neuropsychological Services PC

  • Clinical Neuropsychologist
  • Arlington Heights, IL
  • NPI 1205882313
  NPD
• Christopher D Lubawski LCPC Inc.

  • Community/Behavioral Health Agency
  • Naperville, IL
  • NPI 1508231473
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386720000000",
    "number": "1417067190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "632 CONESTOGA RD",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605632491",
            "telephone_number": "630-975-1610",
            "fax_number": "630-246-6809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2628 83RD ST",
            "city": "DARIEN",
            "state": "IL",
            "postal_code": "605611661",
            "telephone_number": "630-246-6810",
            "fax_number": "630-246-6809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSARLA",
        "first_name": "VIJAYALAKSHMI",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2013-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071005075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah E Stredney, PT
• Bozica Suker, PT
• Farah Sukkari, PHARMD
• Suzanne M Sullivan, LCPC CRC
• Surgical Hand LLC
• Finley Sage Taliaferro
• Francis T Tan, DDS
• Jennifer S Tan, DDS
• Nicholas Gabriel Tanasa
• Syeda Mehak Tariq, FNP

• Psychologist in Darien, IL
• Providers in Darien, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.