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General NPI Number Information
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NPI Number | 1548712797
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Entity Type | Organization
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Legal Business Name | SOCIAL BEHAVIOR SOLUTIONS
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 720 N LARRABEE ST APT 1509
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City | CHICAGO
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State | IL
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Zip | 60654-1874
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Country | US
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Telephone | 847-565-8083
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Fax |
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Provider Business Mailing Address
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Address Line | 720 N LARRABEE ST APT 1509
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City | CHICAGO
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State | IL
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Zip | 60654-1874
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Country | US
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Telephone | 847-565-8083
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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 | IVY LYNN
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Credential | LCSW
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Telephone | 847-565-8083
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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 | 149016923
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License Number State | IL
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