Provider Demographics
NPI:1609016864
Name:AMY J. GARTNER,LCSW, INC.
Entity Type:Organization
Organization Name:AMY J. GARTNER,LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-307-6056
Mailing Address - Street 1:8600 US HIGHWAY 14
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012
Mailing Address - Country:US
Mailing Address - Phone:815-307-6056
Mailing Address - Fax:
Practice Address - Street 1:3210 PRAIRIE VIEW DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8014
Practice Address - Country:US
Practice Address - Phone:815-307-6056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490115341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty