Provider Demographics
NPI:1013382845
Name:ERIN OBRADOVICH, LCSW, LLC
Entity Type:Organization
Organization Name:ERIN OBRADOVICH, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:OBRADOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-935-8107
Mailing Address - Street 1:5100 N RAVENSWOOD
Mailing Address - Street 2:SUITE 231
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1710
Mailing Address - Country:US
Mailing Address - Phone:630-935-8107
Mailing Address - Fax:
Practice Address - Street 1:5100 N RAVENSWOOD AVE
Practice Address - Street 2:SUITE 231
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1710
Practice Address - Country:US
Practice Address - Phone:630-935-8107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0179931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty