Healthcare Provider Details

I. General information

NPI: 1437790425
Provider Name (Legal Business Name): BENJAMIN DAVID ZARIT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 RIDGE AVE FL 2
EVANSTON IL
60202-3328
US

IV. Provider business mailing address

1820 S 25TH AVE
BROADVIEW IL
60155-2864
US

V. Phone/Fax

Practice location:
  • Phone: 708-410-0615
  • Fax:
Mailing address:
  • Phone: 847-316-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150.102109
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: