Healthcare Provider Details

I. General information

NPI: 1518325398
Provider Name (Legal Business Name): DAMEN WELLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 TIMBER HILL RD
HIGHLAND PARK IL
60035-5121
US

IV. Provider business mailing address

814 TIMBER HILL RD
HIGHLAND PARK IL
60035-5121
US

V. Phone/Fax

Practice location:
  • Phone: 646-621-3743
  • Fax:
Mailing address:
  • Phone: 646-621-3743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801116038
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149019993
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29526
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: