Provider Demographics
NPI:1902084098
Name:FERRARA, AMY GRACE (LCSW, CADC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:GRACE
Last Name:FERRARA
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W CHICAGO AVE FL 4
Mailing Address - Street 2:UNION HOUSE, NMH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-4333
Mailing Address - Country:US
Mailing Address - Phone:312-282-6077
Mailing Address - Fax:
Practice Address - Street 1:30 W CHICAGO AVE FL 4
Practice Address - Street 2:UNION HOUSE, NMH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-4333
Practice Address - Country:US
Practice Address - Phone:312-282-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical