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General NPI Number Information
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NPI Number | 1740305093
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Entity Type | Individual
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Provider Name | LISA SORCE SCHMITZ M.S.W, L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 235 HARRISON ST
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City | OAK PARK
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State | IL
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Zip | 60304-1533
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Country | US
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Telephone | 708-717-0758
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Fax |
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Provider Business Mailing Address
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Address Line | 2327 N 78TH AVE
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City | ELMWOOD PARK
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State | IL
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Zip | 60707-3024
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Country | US
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Telephone | 708-717-0758
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | IL
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