Provider Demographics
NPI:1306897087
Name:WALTZER, FRED T (LCSW)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:T
Last Name:WALTZER
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 1:6600 N LINCOLN AVE
Mailing Address - Street 2:SUITE 412
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3620
Mailing Address - Country:US
Mailing Address - Phone:847-568-1672
Mailing Address - Fax:
Practice Address - Street 1:6600 N LINCOLN AVE
Practice Address - Street 2:SUITE 412
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3620
Practice Address - Country:US
Practice Address - Phone:847-568-1672
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
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