=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285458109
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAFE SOCIAL WORK CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2024
-----------------------------------------------------
Last Update Date | 02/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1019 W 110TH ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60643-3741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-452-2301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1019 W 110TH ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60643-3741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-452-2301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | ANJANETTE L YOUNG
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 630-452-2301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------