Provider Demographics
NPI:1629168661
Name:HARRIS, JOHN P (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 N WELLS #2901
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6023
Mailing Address - Country:US
Mailing Address - Phone:312-306-9503
Mailing Address - Fax:
Practice Address - Street 1:1636 N WELLS #2901
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6023
Practice Address - Country:US
Practice Address - Phone:312-306-9503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622421OtherBCBS
IL88423OtherMHN