Provider Demographics
NPI:1184024416
Name:MAREN W. DEAVER, LCSW PLLC
Entity Type:Organization
Organization Name:MAREN W. DEAVER, LCSW PLLC
Other - Org Name:MAREN W. DEAVER LCSW LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-448-8178
Mailing Address - Street 1:1410 GREGORY AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3236
Mailing Address - Country:US
Mailing Address - Phone:847-840-9719
Mailing Address - Fax:
Practice Address - Street 1:2530 CRAWFORD AVE STE 219
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4959
Practice Address - Country:US
Practice Address - Phone:847-840-9719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0140241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.014024OtherLICENSE