Provider Demographics
NPI:1568953156
Name:MALITZ, DEBORAH ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ROSE
Last Name:MALITZ
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 1:617 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3636
Mailing Address - Country:US
Mailing Address - Phone:773-859-1474
Mailing Address - Fax:
Practice Address - Street 1:1217 MCHENRY RD STE 233A
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1379
Practice Address - Country:US
Practice Address - Phone:773-859-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-20
Last Update Date:2018-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0114991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical