Provider Demographics
NPI:1912926528
Name:BEAUCHAMP, DENNIS ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ANTHONY
Last Name:BEAUCHAMP
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 1:2834 W RASCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3214
Mailing Address - Country:US
Mailing Address - Phone:773-989-0466
Mailing Address - Fax:
Practice Address - Street 1:3003 W. TOUHY AVE.
Practice Address - Street 2:COUNCIL FOR JEWISH ELDERLY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645
Practice Address - Country:US
Practice Address - Phone:773-508-1139
Practice Address - Fax:773-262-7084
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
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
IL982440Medicare PIN