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General NPI Number Information
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NPI Number | 1306174099
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Entity Type | Individual
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Provider Name | ANURADHA SPAIN MA, LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | 1010 JORIE BLVD 112
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City | OAK BROOK
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State | IL
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Zip | 60523-2215
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Country | US
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Telephone | 630-240-1188
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Fax |
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Provider Business Mailing Address
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Address Line | 245 S EAST AVE UNIT 1
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City | OAK PARK
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State | IL
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Zip | 60302-3211
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Country | US
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Telephone | 708-613-5140
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.013801
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License Number State | IL
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