Healthcare Provider Details

I. General information

NPI: 1861663809
Provider Name (Legal Business Name): JUDITH FRADIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 NATIONS DR SUITE 208
GURNEE IL
60031-9164
US

IV. Provider business mailing address

1401 MCHENRY RD SUITE 122
BUFFALO GROVE IL
60089-1382
US

V. Phone/Fax

Practice location:
  • Phone: 847-913-0393
  • Fax: 847-913-9630
Mailing address:
  • Phone: 847-913-0393
  • Fax: 847-913-9630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: