Healthcare Provider Details

I. General information

NPI: 1528433786
Provider Name (Legal Business Name): SEAN S MCGREW LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1786 MOON LAKE BLVD SUITE 104
HOFFMAN ESTATES IL
60169-5029
US

IV. Provider business mailing address

1786 MOON LAKE BLVD SUITE 104
HOFFMAN ESTATES IL
60169-5029
US

V. Phone/Fax

Practice location:
  • Phone: 847-755-8090
  • Fax: 847-843-7393
Mailing address:
  • Phone: 847-755-8090
  • Fax: 847-843-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150015284
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149019055
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: