Healthcare Provider Details

I. General information

NPI: 1295984649
Provider Name (Legal Business Name): STEFANIE BETH ADESS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W BELMONT AVE SUITE 407
CHICAGO IL
60657-3200
US

IV. Provider business mailing address

1947 W EVERGREEN AVE APT G
CHICAGO IL
60622-1917
US

V. Phone/Fax

Practice location:
  • Phone: 773-484-6078
  • Fax:
Mailing address:
  • Phone: 773-484-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149009924
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2162884
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: