Provider Demographics
NPI:1811900053
Name:KANDARAS, CHRISTINE STEVICK (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:STEVICK
Last Name:KANDARAS
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 1:340 PORTWINE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3831
Mailing Address - Country:US
Mailing Address - Phone:847-405-0516
Mailing Address - Fax:847-405-0516
Practice Address - Street 1:340 PORTWINE RD
Practice Address - Street 2:
Practice Address - City:RIVERWOODS
Practice Address - State:IL
Practice Address - Zip Code:60015-3831
Practice Address - Country:US
Practice Address - Phone:847-405-0516
Practice Address - Fax:847-405-0516
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
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
IL049-72076OtherBC/BS
IL049-72076OtherBC/BS