Provider Demographics
NPI:1134209380
Name:SHIFFMAN, JUDITH MICHELLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MICHELLE
Last Name:SHIFFMAN
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 1:977 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1400
Mailing Address - Country:US
Mailing Address - Phone:847-361-2334
Mailing Address - Fax:847-549-7005
Practice Address - Street 1:977 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1400
Practice Address - Country:US
Practice Address - Phone:847-361-2334
Practice Address - Fax:847-549-7005
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213566Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION N