Provider Demographics
NPI:1164992434
Name:DANISHEFSKY, JACOB (MSW)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:DANISHEFSKY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:YAKOV
Other - Middle Name:
Other - Last Name:DANISHEFSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:3005 W SHERWIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1133
Mailing Address - Country:US
Mailing Address - Phone:201-970-2976
Mailing Address - Fax:
Practice Address - Street 1:1618 ORRINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5016
Practice Address - Country:US
Practice Address - Phone:847-328-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical