Provider Demographics
NPI:1740957976
Name:KLEMMER, CARY LEONARD (PHD, LCSW)
Entity type:Individual
Prefix:
First Name:CARY
Middle Name:LEONARD
Last Name:KLEMMER
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 CHICAGO AVE STE 7B
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-6017
Mailing Address - Country:US
Mailing Address - Phone:773-231-8407
Mailing Address - Fax:
Practice Address - Street 1:1604 CHICAGO AVE STE 7B
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-6017
Practice Address - Country:US
Practice Address - Phone:773-231-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1045771041C0700X
IL149.0242341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical