Basic Information
Provider Information
NPI: 1619467669
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KATZ
FirstName: ROBIN
MiddleName: BETH
NamePrefix: MS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 680 N LAKE SHORE DR
Address2:  
City: CHICAGO
State: IL
PostalCode: 606114546
CountryCode: US
TelephoneNumber: 3126956868
FaxNumber: 3126951106
Practice Location
Address1: 675 N SAINT CLAIR ST # 21
Address2:  
City: CHICAGO
State: IL
PostalCode: 606115975
CountryCode: US
TelephoneNumber: 3126958186
FaxNumber: 3126951106
Other Information
ProviderEnumerationDate: 05/15/2018
LastUpdateDate: 11/29/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X149.019690ILY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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