Provider Demographics
NPI:1003998204
Name:WACHTEL SHAPIRO, LYNN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:
Last Name:WACHTEL SHAPIRO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:WACHTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17732 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477
Mailing Address - Country:US
Mailing Address - Phone:708-342-1773
Mailing Address - Fax:708-342-1780
Practice Address - Street 1:17732 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477
Practice Address - Country:US
Practice Address - Phone:708-342-1773
Practice Address - Fax:708-342-1780
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16606101YA0400X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical