Healthcare Provider Details

I. General information

NPI: 1982089587
Provider Name (Legal Business Name): FADIA DAMRA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CALENDAR CT STE 201
LA GRANGE IL
60525-6327
US

IV. Provider business mailing address

23 CALENDAR CT STE 207
LA GRANGE IL
60525-6327
US

V. Phone/Fax

Practice location:
  • Phone: 708-617-9336
  • Fax: 708-995-3806
Mailing address:
  • Phone: 708-745-5277
  • Fax: 708-795-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149025267
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: