Provider Demographics
NPI:1386980423
Name:KATZ, JENNIFER LORI (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LORI
Last Name:KATZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 REVERE DR
Mailing Address - Street 2:UNIT 8
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1558
Mailing Address - Country:US
Mailing Address - Phone:847-780-6620
Mailing Address - Fax:
Practice Address - Street 1:155 REVERE DR
Practice Address - Street 2:UNIT 8
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1558
Practice Address - Country:US
Practice Address - Phone:847-780-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490141711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical