Provider Demographics
NPI:1164003281
Name:CEDENO, MARIA SUSANA (LCPC, CCTP, ICDVP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:SUSANA
Last Name:CEDENO
Suffix:
Gender:F
Credentials:LCPC, CCTP, ICDVP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10537 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1933
Mailing Address - Country:US
Mailing Address - Phone:708-974-5133
Mailing Address - Fax:312-986-4315
Practice Address - Street 1:10537 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1933
Practice Address - Country:US
Practice Address - Phone:708-974-5133
Practice Address - Fax:312-986-4315
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012305101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor