Provider Demographics
NPI:1114057346
Name:RUFFOLO, LAWRENCE MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:MICHAEL
Last Name:RUFFOLO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 HARTREY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2562
Mailing Address - Country:US
Mailing Address - Phone:847-338-2564
Mailing Address - Fax:312-906-5199
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE 2900
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2103
Practice Address - Country:US
Practice Address - Phone:847-338-2564
Practice Address - Fax:312-906-5199
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0023351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical