Healthcare Provider Details

I. General information

NPI: 1255573127
Provider Name (Legal Business Name): ANGELA T MICHELINI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 KIRCHOFF RD
ROLLING MEADOWS IL
60008-1824
US

IV. Provider business mailing address

2604 DEMPSTER ST STE 307
PARK RIDGE IL
60068-8427
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-3880
  • Fax: 847-618-3889
Mailing address:
  • Phone: 847-544-5102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.010089
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: