Provider Demographics
NPI:1023126273
Name:WARE, PHILIP L (LCSW)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:L
Last Name:WARE
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 1:800 E 170TH PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3405
Mailing Address - Country:US
Mailing Address - Phone:708-337-5433
Mailing Address - Fax:708-210-1430
Practice Address - Street 1:9415 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-6700
Practice Address - Country:US
Practice Address - Phone:708-337-5433
Practice Address - Fax:708-210-1430
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490075881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149007588Medicaid
IL149007588Medicaid
P91208Medicare UPIN