Provider Demographics
NPI:1154893089
Name:MICHAEL A CONFORTI LCSW INC
Entity type:Organization
Organization Name:MICHAEL A CONFORTI LCSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONFORTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-404-1674
Mailing Address - Street 1:734 ASBURY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2158
Mailing Address - Country:US
Mailing Address - Phone:312-404-1674
Mailing Address - Fax:
Practice Address - Street 1:734 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2158
Practice Address - Country:US
Practice Address - Phone:312-404-1674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty