Provider Demographics
NPI:1336241819
Name:LEWANDOWSKI, LINDA SUSAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUSAN
Last Name:LEWANDOWSKI
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 1:179 LIONS GATE DR
Mailing Address - Street 2:
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5398
Mailing Address - Country:US
Mailing Address - Phone:847-650-1835
Mailing Address - Fax:847-492-1003
Practice Address - Street 1:1609 SHERMAN AV
Practice Address - Street 2:SUITE 319
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-650-1835
Practice Address - Fax:847-492-1003
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490042601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001633828OtherBLUE CROSS BLUE SHIELD PR
IL0001633828OtherBLUE CROSS BLUE SHIELD PR