| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2628 83rd St, Darien, Illinois |
| Authorized Official Name and Position | Vijayalakshmi Susarla (CLINICAL PSYCHOLOGIST/PRESIDENT) |
| Authorized Official Contact | 6309751610 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
632 Conestoga Rd Naperville IL 60563-2491 Ph: (630) 975-1610 | 2628 83rd St Darien IL 60561-1661 Ph: (630) 975-1610 |
| NPI Number | 1649298324 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 12/11/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649298324 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071005075 (Illinois) | Primary |
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