Healthcare Provider Details

I. General information

NPI: 1467781484
Provider Name (Legal Business Name): JEFFREY M SOLOTOROFF L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 GROSS POINT RD STE 3900
SKOKIE IL
60076-5085
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-503-2065
  • Fax: 847-570-2570
Mailing address:
  • Phone: 847-982-6715
  • Fax: 847-982-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-005837
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: