Paul J. Detaege, LCSW, P.C.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

149008180 Issued in IL

Legal business name

PAUL J. DETAEGE, LCSW, P.C.

Practice address

5215 N Ravenswood Ave
Suite 314
Chicago, IL 60640-1668

Phone

(773) 988-4965

NPI assigned

Jul 20, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul J Detaege, LCSWNPI 1598887580

Title

President

Phone

(773) 988-4965

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul J. Detaege, L.C.S.W.

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1598887580
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311120000000",
    "number": "1861780025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5215 N RAVENSWOOD AVE",
            "address_2": "SUITE 314",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401668",
            "telephone_number": "773-988-4965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 N RAVENSWOOD AVE",
            "address_2": "SUITE 314",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401668",
            "telephone_number": "773-988-4965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL J. DETAEGE, LCSW, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-20",
        "last_updated": "2011-07-20",
        "status": "A",
        "authorized_official_last_name": "DETAEGE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-988-4965",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "149008180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1598887580",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul Davis Pharmacy
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• Paul M. Stec Il DDS PC
• Paul Pasulka, PH.D., P.C.
• Paul Poncza DDS PC
• Paul Ruzila D.C. LTD.
• Paul T. Hackett D.C., P.C.

• Community/Behavioral Health Agency in Chicago, IL
• Providers in Chicago, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.