Provider Demographics
NPI:1528668373
Name:NOVAK, STEPHANIE CABALLERO (LCSW, CRSS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CABALLERO
Last Name:NOVAK
Suffix:
Gender:F
Credentials:LCSW, CRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 N LEAMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1433
Mailing Address - Country:US
Mailing Address - Phone:872-230-6340
Mailing Address - Fax:
Practice Address - Street 1:LIFE CARE WELLNESS, INC.
Practice Address - Street 2:800 ROOSEVELT RD BUILDING C SUITE 206
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137
Practice Address - Country:US
Practice Address - Phone:630-423-5935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490226281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical