Provider Demographics
NPI:1184026932
Name:STERN, JEREMY (LCSW, LPHA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:STERN
Suffix:
Gender:M
Credentials:LCSW, LPHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 W FARGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1222
Mailing Address - Country:US
Mailing Address - Phone:713-875-0890
Mailing Address - Fax:
Practice Address - Street 1:2943 W FARGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1222
Practice Address - Country:US
Practice Address - Phone:713-875-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150014041104100000X
IL1490172951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker