Healthcare Provider Details

I. General information

NPI: 1073813002
Provider Name (Legal Business Name): HOWARD MICHAEL GELB LCSW, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 N BROADWAY ST 207
CHICAGO IL
60613-6074
US

IV. Provider business mailing address

441 W MELROSE ST 207
CHICAGO IL
60657-3845
US

V. Phone/Fax

Practice location:
  • Phone: 773-248-1009
  • Fax:
Mailing address:
  • Phone: 773-248-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.017334
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: