1851712392 NPI number — ERIN DANIELLE OBRADOVICH L.C.S.W

Table of content: (NPI 1730112426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851712392 NPI number — ERIN DANIELLE OBRADOVICH L.C.S.W

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBRADOVICH
Provider First Name:
ERIN
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851712392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 N. RAVENSWOOD AVE.
Provider Second Line Business Mailing Address:
SUITE 231
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60657-1710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-935-8107
Provider Business Mailing Address Fax Number:
773-661-4762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 N. RAVENSWOOD AVE.
Provider Second Line Business Practice Location Address:
SUITE 231
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-935-8107
Provider Business Practice Location Address Fax Number:
773-661-4762
Provider Enumeration Date:
12/31/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  150.014702 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 149.017993 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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