Healthcare Provider Details

I. General information

NPI: 1194867614
Provider Name (Legal Business Name): CATHERINE RENE SPENCER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 REVERE DR SUITE 100
NORTHBROOK IL
60062-1566
US

IV. Provider business mailing address

350 RED OAK LN
HIGHLAND PARK IL
60035-4228
US

V. Phone/Fax

Practice location:
  • Phone: 847-291-6815
  • Fax:
Mailing address:
  • Phone: 847-681-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-010576
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: