Healthcare Provider Details

I. General information

NPI: 1497483895
Provider Name (Legal Business Name): ELEANOR CLAIRE MULSHINE I LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 2029
CHICAGO IL
60602-3611
US

IV. Provider business mailing address

30 N MICHIGAN AVE STE 2029
CHICAGO IL
60602-3611
US

V. Phone/Fax

Practice location:
  • Phone: 773-345-3495
  • Fax: 855-792-0240
Mailing address:
  • Phone: 773-345-3495
  • Fax: 855-792-0240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.021413
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: