Provider Demographics
NPI:1538210455
Name:LAGEN, J MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:J
Middle Name:MICHAEL
Last Name:LAGEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:JOHM
Other - Middle Name:MICHAEL
Other - Last Name:LAGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2835 N SHEFFIELD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-204-4984
Mailing Address - Fax:773-281-3429
Practice Address - Street 1:2835 N SHEFFIELD AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5081
Practice Address - Country:US
Practice Address - Phone:773-204-4984
Practice Address - Fax:773-281-3429
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health