Provider Demographics
NPI:1477638948
Name:MICHAEL L KLESTINSKI & ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MICHAEL L KLESTINSKI & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KLESTINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-367-6900
Mailing Address - Street 1:1117 S MILWAUKEE AVE
Mailing Address - Street 2:FORUM SQUARE BUILDING B SUITE 2
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3798
Mailing Address - Country:US
Mailing Address - Phone:847-367-6900
Mailing Address - Fax:847-816-6447
Practice Address - Street 1:1117 S MILWAUKEE AVE
Practice Address - Street 2:FORUM SQUARE BUILDING B SUITE 2
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3798
Practice Address - Country:US
Practice Address - Phone:847-367-6900
Practice Address - Fax:847-816-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL936590Medicare ID - Type Unspecified