Provider Demographics
NPI:1629029624
Name:KITE, TRACEY LIPSIG (LCSW)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LIPSIG
Last Name:KITE
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 1:1516 SEQUOIA TRL
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2019
Mailing Address - Country:US
Mailing Address - Phone:847-901-3488
Mailing Address - Fax:847-901-3889
Practice Address - Street 1:3000 DUNDEE RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2422
Practice Address - Country:US
Practice Address - Phone:847-901-3488
Practice Address - Fax:847-901-3889
Is Sole Proprietor?:No
Enumeration Date:2006-05-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.007083104100000X
IL1490070831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
211767Medicare UPIN