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General NPI Number Information
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NPI Number | 1346597259
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Entity Type | Organization
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Legal Business Name | MELISSA A MANKOFF LCSW LLC
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 977 LAKEVIEW PKWY
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City | VERNON HILLS
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State | IL
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Zip | 60061-1400
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Country | US
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Telephone | 847-791-3450
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Fax | 847-913-9740
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Provider Business Mailing Address
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Address Line | 1636 N WELLS ST 1807
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City | CHICAGO
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State | IL
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Zip | 60614-6037
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Country | US
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Telephone | 847-791-3450
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MELISSA A MANKOFF
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Credential | LCSW
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Telephone | 847-791-3450
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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 | 149.014466
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License Number State | IL
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