Provider Demographics
NPI:1972513075
Name:KAUFER, DEAN C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:C
Last Name:KAUFER
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 1:3139 N LINCOLN AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-248-8434
Mailing Address - Fax:
Practice Address - Street 1:3139 N LINCOLN AVE
Practice Address - Street 2:STE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-248-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149001324104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001605737OtherBLUE CROSS BLUE SHIELD
959390Medicare ID - Type Unspecified