Provider Demographics
NPI:1437670510
Name:STOLBERG, ALISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:STOLBERG
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 1:924 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-2919
Mailing Address - Country:US
Mailing Address - Phone:847-607-9071
Mailing Address - Fax:
Practice Address - Street 1:240 E ILLINOIS RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1943
Practice Address - Country:US
Practice Address - Phone:847-723-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149018091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical