Provider Demographics
NPI:1669545919
Name:SCHIFFER, LISE ELLEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LISE
Middle Name:ELLEN
Last Name:SCHIFFER
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 1:6900 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4604
Mailing Address - Country:US
Mailing Address - Phone:772-508-5301
Mailing Address - Fax:773-508-9010
Practice Address - Street 1:6900 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-4604
Practice Address - Country:US
Practice Address - Phone:772-508-5301
Practice Address - Fax:773-508-9010
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.003059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health