Healthcare Provider Details

I. General information

NPI: 1275356222
Provider Name (Legal Business Name): AFSHAN MAHMOOOD LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 N CENTRAL AVE
CHICAGO IL
60639-1351
US

IV. Provider business mailing address

7320 N KOSTNER AVE
LINCOLNWOOD IL
60712-1922
US

V. Phone/Fax

Practice location:
  • Phone: 773-360-1389
  • Fax:
Mailing address:
  • Phone: 773-552-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.114748
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: