Provider Demographics
NPI:1225234297
Name:LASER, ALBERT WOLFE (LCPC)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:WOLFE
Last Name:LASER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 N BERNARD ST
Mailing Address - Street 2:3RD FL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3407
Mailing Address - Country:US
Mailing Address - Phone:773-600-4205
Mailing Address - Fax:
Practice Address - Street 1:LYDIA HOME ASSOCIATION
Practice Address - Street 2:4300 W IRVING PARK RD
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2825
Practice Address - Country:US
Practice Address - Phone:773-736-1447
Practice Address - Fax:773-736-6970
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health