Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 071007294 | IL |
NPI | 1043566144 |
---|---|
Provider Name | Suzanne M Pinto |
First Address | Warrenville, IL 60555-4023 |
Second Address | Warrenville, IL 60555-4023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2012 |
Last Update Date | 15/06/2019 |