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General NPI Number Information
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NPI Number | 1619419769
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Entity Type | Organization
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Legal Business Name | THE SOCIAL SKILLS PLACE, INC.
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Dates
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Enumeration Date | 11/07/2016
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 464 CENTRAL AVE SUITE 6
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City | NORTHFIELD
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State | IL
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Zip | 60093-3040
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Country | US
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Telephone | 847-446-7430
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Fax | 847-446-7430
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Provider Business Mailing Address
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Address Line | 464 CENTRAL AVE SUITE 6
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City | NORTHFIELD
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State | IL
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Zip | 60093-3040
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Country | US
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Telephone | 847-446-7430
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Fax | 847-446-7430
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Authorized Official
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Title or Position | PRESIDENT/SOCIAL WORKER
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Name | MS. SUSAN B STERN
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Credential | LCSW
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Telephone | 847-507-8834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149.012129
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License Number State | IL
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