Provider Demographics
NPI:1346312055
Name:MISTELE, BARBARA STITT (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:STITT
Last Name:MISTELE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 ROCKLAND RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1782
Mailing Address - Country:US
Mailing Address - Phone:847-986-3717
Mailing Address - Fax:
Practice Address - Street 1:655 ROCKLAND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1782
Practice Address - Country:US
Practice Address - Phone:847-986-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490014061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04907177OtherBLUE CROSS PROVIDER NMBR
IL04907177OtherBLUE CROSS PROVIDER NMBR