Provider Demographics
NPI:1740819556
Name:LICHTENSTEIN, SHIRA (AM, LSW)
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:LICHTENSTEIN
Suffix:
Gender:F
Credentials:AM, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7141 N KEDZIE AVE APT 710
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2824
Mailing Address - Country:US
Mailing Address - Phone:847-338-0075
Mailing Address - Fax:
Practice Address - Street 1:3330 OLD GLENVIEW RD STE 14
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2963
Practice Address - Country:US
Practice Address - Phone:312-508-3645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical