Healthcare Provider Details

I. General information

NPI: 1730699935
Provider Name (Legal Business Name): ROBERT ERIC AGNOLI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 COMMERCE CT STE 250
LISLE IL
60532-3674
US

IV. Provider business mailing address

415 LAKE AVE
DOWNERS GROVE IL
60515-3070
US

V. Phone/Fax

Practice location:
  • Phone: 630-518-2490
  • Fax:
Mailing address:
  • Phone: 630-518-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149006015
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: