Healthcare Provider Details

I. General information

NPI: 1356866909
Provider Name (Legal Business Name): MADELINE FRIEDMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3166 N LINCOLN AVE STE 314
CHICAGO IL
60657-3119
US

IV. Provider business mailing address

3166 N LINCOLN AVE STE 314
CHICAGO IL
60657-3119
US

V. Phone/Fax

Practice location:
  • Phone: 312-588-6158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149020448
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: