Provider Demographics
NPI:1831325299
Name:BIRONG, WILLIAM PETER (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PETER
Last Name:BIRONG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 PINGREE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1725
Mailing Address - Country:US
Mailing Address - Phone:815-501-4840
Mailing Address - Fax:
Practice Address - Street 1:1095 PINGREE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1725
Practice Address - Country:US
Practice Address - Phone:815-501-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0136081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical