Healthcare Provider Details

I. General information

NPI: 1144592726
Provider Name (Legal Business Name): LAUREN GUMBINER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN TEITELBAUM MSW, LCSW

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 LINCOLN AVE SUITE 205
WINNETKA IL
60093-2353
US

IV. Provider business mailing address

3452 N BELL AVE #2
CHICAGO IL
60618-6002
US

V. Phone/Fax

Practice location:
  • Phone: 847-920-4620
  • Fax:
Mailing address:
  • Phone: 773-891-9623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.014827
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: