Provider Demographics
NPI:1669526265
Name:BURNSTEIN, KENNETH AARON (LCSW)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:AARON
Last Name:BURNSTEIN
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 1:625 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1709
Mailing Address - Country:US
Mailing Address - Phone:630-418-9484
Mailing Address - Fax:
Practice Address - Street 1:715 LAKE ST STE 310
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1412
Practice Address - Country:US
Practice Address - Phone:630-418-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490087961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204332Medicare ID - Type Unspecified