Paul J. Detaege, Lcsw, P.C.
Community/Behavioral Health in Chicago, IL. Organization (NPI-2).
NPI number1861780025
StatusActive
Last updated in NPPESJul 20, 2011
Details
- NPI
- 1861780025
- Entity type
- Organization (NPI-2)
- Legal business name
- Paul J. Detaege, Lcsw, P.C.
- Organization subpart
- No
- Enumeration date
- Jul 20, 2011
- Last updated
- Jul 20, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | 149008180 | IL | Yes |
Practice location
5215 N Ravenswood AveSuite 314
Chicago, IL 60640-1668
Phone 773-988-4965
Mailing address
5215 N Ravenswood AveSuite 314
Chicago, IL 60640-1668
Phone 773-988-4965
Authorized official
Paul J Detaege
President
7739884965
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