Healthcare Provider Details

I. General information

NPI: 1063558625
Provider Name (Legal Business Name): LOIS N. SILVERSTEIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 CHURCH ST SUITE 409
EVANSTON IL
60201-4508
US

IV. Provider business mailing address

636 CHURCH ST SUITE 409
EVANSTON IL
60201-4508
US

V. Phone/Fax

Practice location:
  • Phone: 847-475-8342
  • Fax: 847-432-7331
Mailing address:
  • Phone: 847-475-8342
  • Fax: 847-432-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149.000461
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: