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General NPI Number Information
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NPI Number | 1336858687
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Entity Type | Individual
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Provider Name | LAVORIS LEE
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Gender | Male
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 1400 W GREENLEAF AVE
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City | CHICAGO
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State | IL
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Zip | 60626-2805
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Country | US
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Telephone | 773-508-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 504 WEBB ST
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City | CALUMET CITY
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State | IL
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Zip | 60409-4720
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Country | US
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Telephone | 773-571-6803
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149025663
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License Number State | IL
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