MEDICARE: MR. PAUL J. DETAEGE L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.008180	IL

General Provider Information

NPI Number	:	1598887580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL J. DETAEGE L.C.S.W.

Provider Business Mailing Address
First Line	:	5215 N RAVENSWOOD AVE STE 314
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1670
Country	:	US
Telephone Number	:	773-988-4965
Fax Number	:

Provider Business Practice Location Address
First Line	:	5215 N RAVENSWOOD AVE STE 314
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1670
Country	:	US
Telephone Number	:	773-988-4965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/05/2022

Similar Medicare Providers

1780005546 — DR. LAURA FRAINT PSY.D
Practice Location Address:

5215 N RAVENSWOOD AVE STE 214
CHICAGO, IL
60640-1670

Practice Phone: 312-460-3858
Practice Fax:

1144606385 — SERENA PESCH
Practice Location Address:

5215 N RAVENSWOOD AVE , STE 210
CHICAGO, IL
60640-1670

Practice Phone: 773-654-3179
Practice Fax: 773-973-0353

1528511698 — TANYA IMAM LCSW
Practice Location Address:

5215 N RAVENSWOOD AVE STE 211
CHICAGO, IL
60640-1670

Practice Phone: 309-838-0268
Practice Fax:

1861949729 — MS. ELIZABETH STOLTENBERG MS, MSW, LCSW
Practice Location Address:

5215 N RAVENSWOOD AVE STE 214
CHICAGO, IL
60640-1670

Practice Phone: 773-888-2158
Practice Fax:

1841738424 — MISS LAUREN LOUISE BREIT LCPC, CADC, NCC, CST
Practice Location Address:

5215 N RAVENSWOOD AVE STE 312
CHICAGO, IL
60640-1670

Practice Phone: 872-239-5253
Practice Fax:

1821537978 — CLEA ROSE MIRZA JAMES
Practice Location Address:

5215 N RAVENSWOOD AVE STE 211
CHICAGO, IL
60640-1670

Practice Phone: 312-767-7855
Practice Fax:

Directions to “ MR. PAUL J. DETAEGE L.C.S.W.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.