Healthcare Provider Details

I. General information

NPI: 1750614053
Provider Name (Legal Business Name): DANIEL ALLEN KOBOSKY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DRIVE SUITE 800
CHICAGO IL
60611
US

IV. Provider business mailing address

680 N LAKE SHORE DRIVE SUITE 800
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-642-7230
  • Fax:
Mailing address:
  • Phone: 312-642-7230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00009593
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149008608
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: