Provider Demographics
NPI:1134199011
Name:STASTNY, JANE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:STASTNY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 NOYES ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2071
Mailing Address - Country:US
Mailing Address - Phone:847-491-6022
Mailing Address - Fax:
Practice Address - Street 1:671 N WABASH AVE
Practice Address - Street 2:ST JAMES CATHEDRAL COUNSELING CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-337-5874
Practice Address - Fax:312-337-9243
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
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
581570Medicare ID - Type Unspecified