Provider Demographics
NPI:1881574101
Name:NEWBERRY, SUSAN M (CADC, CODP 1, CHAA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:CADC, CODP 1, CHAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 SPRUCE LN UNIT G
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-4820
Mailing Address - Country:US
Mailing Address - Phone:779-220-1383
Mailing Address - Fax:
Practice Address - Street 1:1175 SPRUCE LN UNIT G
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4820
Practice Address - Country:US
Practice Address - Phone:779-220-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL195000101YM0800X
IL175T00000X
MINA246Y00000X
IL37240101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information