Healthcare Provider Details

I. General information

NPI: 1003108903
Provider Name (Legal Business Name): AVIVA CAHN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N MICHIGAN AVE SUITE 1801
CHICAGO IL
60601-3901
US

IV. Provider business mailing address

3200 N LAKE SHORE DR APARTMENT 2704
CHICAGO IL
60657-3952
US

V. Phone/Fax

Practice location:
  • Phone: 773-301-8576
  • Fax:
Mailing address:
  • Phone: 773-871-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149006633
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: