Provider Demographics
NPI:1639186844
Name:STERN, DEBRA ANN (LCSW LMFT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:STERN
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LAKE ST
Mailing Address - Street 2:STE 502A
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301
Mailing Address - Country:US
Mailing Address - Phone:773-525-7942
Mailing Address - Fax:773-525-7940
Practice Address - Street 1:1010 LAKE ST
Practice Address - Street 2:STE 502A
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:773-525-7942
Practice Address - Fax:773-525-7940
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL38907Medicare ID - Type Unspecified