Healthcare Provider Details

I. General information

NPI: 1619673514
Provider Name (Legal Business Name): ELIZABETH LAVIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 1621
CHICAGO IL
60602-3669
US

IV. Provider business mailing address

30 N MICHIGAN AVE STE 1621
CHICAGO IL
60602-3669
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: