Individual
AUDREY CANTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-000520
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149-000520
LCSW
IL
Enumeration date
03/13/2007
Last updated
07/28/2014
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