Provider Demographics
NPI:1053697342
Name:ROSE, LAUREN CHAVA (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:CHAVA
Last Name:ROSE
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 1:4719 N WINCHESTER AVE
Mailing Address - Street 2:APARTMENT 3D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4719 N WINCHESTER AVE
Practice Address - Street 2:APARTMENT 3D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4349
Practice Address - Country:US
Practice Address - Phone:847-736-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490149091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical