Provider Demographics
NPI:1396754982
Name:MATTHEWS-PLUTA, KELLY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:MATTHEWS-PLUTA
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 1:124 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-4241
Mailing Address - Country:US
Mailing Address - Phone:847-441-0117
Mailing Address - Fax:
Practice Address - Street 1:3545 LAKE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1058
Practice Address - Country:US
Practice Address - Phone:847-251-7350
Practice Address - Fax:847-853-2600
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490080101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical