Provider Demographics
NPI:1750394680
Name:CALLISTEIN, DANIEL (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:CALLISTEIN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 FRONTAGE RD
Mailing Address - Street 2:SUITE 3764
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1202
Mailing Address - Country:US
Mailing Address - Phone:847-501-0281
Mailing Address - Fax:847-784-1744
Practice Address - Street 1:550 FRONTAGE RD
Practice Address - Street 2:SUITE 3764
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1202
Practice Address - Country:US
Practice Address - Phone:847-501-0281
Practice Address - Fax:847-784-1744
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623317OtherBLUE CROSS BLUE SHIELD