Provider Demographics
NPI:1144592726
Name:GUMBINER, LAUREN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GUMBINER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:TEITELBAUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:3452 N BELL AVE
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6002
Mailing Address - Country:US
Mailing Address - Phone:773-891-9623
Mailing Address - Fax:
Practice Address - Street 1:552 LINCOLN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2353
Practice Address - Country:US
Practice Address - Phone:847-920-4620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0148271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical