Provider Demographics
NPI:1902168883
Name:GARVER, JOHN ANSON JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANSON
Last Name:GARVER
Suffix:JR
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 1:653 W BRIAR PL
Mailing Address - Street 2:APT. 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-8350
Mailing Address - Country:US
Mailing Address - Phone:917-826-2474
Mailing Address - Fax:
Practice Address - Street 1:3656 N. HALSTED ST.
Practice Address - Street 2:CENTER ON HALSTED
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613
Practice Address - Country:US
Practice Address - Phone:773-661-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0152061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical