Provider Demographics
NPI:1871160069
Name:KUMAGAI, LORRAINE AKANE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:AKANE
Last Name:KUMAGAI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:AKANE
Other - Middle Name:
Other - Last Name:KUMAGAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:O 710 S PAULINA ST
Mailing Address - Street 2:STE 438
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:708-850-3869
Mailing Address - Fax:
Practice Address - Street 1:710 S PAULINA ST STE 438
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3808
Practice Address - Country:US
Practice Address - Phone:312-947-5338
Practice Address - Fax:312-563-0668
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490225531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical