Healthcare Provider Details

I. General information

NPI: 1154523454
Provider Name (Legal Business Name): STEPHANIE FARISS JD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E WASHINGTON ST STE 1333
CHICAGO IL
60602-1708
US

IV. Provider business mailing address

25 E WASHINGTON ST STE 1333
CHICAGO IL
60602-1708
US

V. Phone/Fax

Practice location:
  • Phone: 312-422-1281
  • Fax: 312-422-9339
Mailing address:
  • Phone: 312-422-1281
  • Fax: 312-422-9339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberIL149006322
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: