Healthcare Provider Details

I. General information

NPI: 1811773104
Provider Name (Legal Business Name): JULIA YACCARINO LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SKOKIE BLVD STE 218
NORTHBROOK IL
60062-4043
US

IV. Provider business mailing address

900 SKOKIE BLVD STE 218
NORTHBROOK IL
60062-4043
US

V. Phone/Fax

Practice location:
  • Phone: 847-668-4295
  • Fax:
Mailing address:
  • Phone: 847-668-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150111141
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150111141
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: