Healthcare Provider Details

I. General information

NPI: 1912825290
Provider Name (Legal Business Name): DENISE MARIE ANDERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 N RAVENSWOOD AVE
CHICAGO IL
60613-2193
US

IV. Provider business mailing address

5048 N MANGO AVE UNIT 1
CHICAGO IL
60630-4609
US

V. Phone/Fax

Practice location:
  • Phone: 773-537-3617
  • Fax:
Mailing address:
  • Phone: 574-386-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.041160
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: