Healthcare Provider Details

I. General information

NPI: 1891061644
Provider Name (Legal Business Name): DAVID ANDES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

V. Phone/Fax

Practice location:
  • Phone: 773-516-7165
  • Fax: 312-569-8986
Mailing address:
  • Phone: 773-516-7165
  • Fax: 312-569-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149 009515
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: