Provider Demographics
NPI:1619008992
Name:DENATALE, LAURA MICK (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MICK
Last Name:DENATALE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:MICK
Other - Last Name:OROGUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6700 N MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4620
Mailing Address - Country:US
Mailing Address - Phone:847-602-2876
Mailing Address - Fax:847-602-2876
Practice Address - Street 1:636 CHURCH ST STE 406
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4580
Practice Address - Country:US
Practice Address - Phone:847-602-2876
Practice Address - Fax:847-602-2876
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01490081481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622876OtherBCBSIL PIN