Healthcare Provider Details

I. General information

NPI: 1679696504
Provider Name (Legal Business Name): LOREN HART DEUTSCH L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 GREEN BAY RD SUITE 3
WINNETKA IL
60093-1768
US

IV. Provider business mailing address

990 GREEN BAY RD SUITE 3
WINNETKA IL
60093-1768
US

V. Phone/Fax

Practice location:
  • Phone: 847-446-5822
  • Fax: 847-784-0187
Mailing address:
  • Phone: 847-446-5822
  • Fax: 847-745-0187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: