Provider Demographics
NPI:1578028783
Name:RADES, LAURIE MARIA (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:MARIA
Last Name:RADES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:MARIA
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3117 N PAULINA ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6780
Mailing Address - Country:US
Mailing Address - Phone:773-844-8456
Mailing Address - Fax:
Practice Address - Street 1:5756 N RIDGE AVE STE 9
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-5332
Practice Address - Country:US
Practice Address - Phone:773-417-5976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490093511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical