Provider Demographics
NPI:1255440996
Name:KANTER, RANDY PHILIP (L CSW)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:PHILIP
Last Name:KANTER
Suffix:
Gender:M
Credentials:L CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025
Mailing Address - Country:US
Mailing Address - Phone:847-927-3385
Mailing Address - Fax:
Practice Address - Street 1:3248 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:847-927-3385
Practice Address - Fax:847-470-0741
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-000513104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker