Healthcare Provider Details

I. General information

NPI: 1235104647
Provider Name (Legal Business Name): STEPHEN LANTERMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 177TH ST
LANSING IL
60438-1722
US

IV. Provider business mailing address

2325 177TH ST
LANSING IL
60438-1722
US

V. Phone/Fax

Practice location:
  • Phone: 708-895-7310
  • Fax: 708-895-7602
Mailing address:
  • Phone: 708-895-7310
  • Fax: 708-895-7602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149012394
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: