Provider Demographics
NPI:1598272585
Name:BOUTROSS, THERESA MCCAY (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MCCAY
Last Name:BOUTROSS
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:MCCAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CADC
Mailing Address - Street 1:874 GREENBAY RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093
Mailing Address - Country:US
Mailing Address - Phone:312-610-0694
Mailing Address - Fax:
Practice Address - Street 1:91 ABBOTTSFORD RD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-4264
Practice Address - Country:US
Practice Address - Phone:312-953-1243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0098341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical