Provider Demographics
NPI:1134464050
Name:WEINSTEIN, SAMANTHA JUNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JUNE
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W MADISON ST
Mailing Address - Street 2:UNIT 705
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3369
Mailing Address - Country:US
Mailing Address - Phone:201-463-8855
Mailing Address - Fax:
Practice Address - Street 1:901 W MADISON ST
Practice Address - Street 2:UNIT 705
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3369
Practice Address - Country:US
Practice Address - Phone:201-463-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490156001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical