1851413611 NPI number — MRS. SUSAN BUIVIDAS CAIN LCSW

Table of content: MRS. SUSAN BUIVIDAS CAIN LCSW (NPI 1851413611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851413611 NPI number — MRS. SUSAN BUIVIDAS CAIN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAIN
Provider First Name:
SUSAN
Provider Middle Name:
BUIVIDAS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAIN
Provider Other First Name:
SUSAN
Provider Other Middle Name:
BUIVIDAS
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1851413611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1615 STODDARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEATON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60187-3336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-510-9880
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1195 SUMMERHILL DR
Provider Second Line Business Practice Location Address:
SUITE S500
Provider Business Practice Location Address City Name:
LISLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60532-3160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-971-5074
Provider Business Practice Location Address Fax Number:
630-971-5076
Provider Enumeration Date:
04/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)