Provider Demographics
NPI:1447584420
Name:WHITE, JOHN (LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WHITE
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 1:8401 CRAWFORD AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2154
Mailing Address - Country:US
Mailing Address - Phone:847-423-2625
Mailing Address - Fax:847-737-1663
Practice Address - Street 1:8401 CRAWFORD AVE
Practice Address - Street 2:STE 106
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2154
Practice Address - Country:US
Practice Address - Phone:847-423-2625
Practice Address - Fax:847-737-1663
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490058021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical