Provider Demographics
NPI:1851449276
Name:NEVILLE, KATHALEEN RENE (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:KATHALEEN
Middle Name:RENE
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 NORTH GREENLEAF AVE
Mailing Address - Street 2:SUITE 228
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-263-5872
Mailing Address - Fax:847-263-5850
Practice Address - Street 1:135 N GREENLEAF AVE
Practice Address - Street 2:SUITE 228
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-263-5872
Practice Address - Fax:847-263-5850
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490047581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL495982OtherVALUE OPTIONS
IL4905163OtherBLUE CROSS BLUE SHIELD