Provider Demographics
NPI:1013395789
Name:BOARD, AMY E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:E
Last Name:BOARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:FIBICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:700 N SACRAMENTO BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1046
Mailing Address - Country:US
Mailing Address - Phone:773-916-4084
Mailing Address - Fax:
Practice Address - Street 1:700 N SACRAMENTO BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1046
Practice Address - Country:US
Practice Address - Phone:773-916-4084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0167361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical