Provider Demographics
NPI:1093176497
Name:BORYSIAK, MARGARET (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:BORYSIAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:HULS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 W BRADLEY PL STE 100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4716
Mailing Address - Country:US
Mailing Address - Phone:773-649-0760
Mailing Address - Fax:224-205-3757
Practice Address - Street 1:2500 W BRADLEY PL STE 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618
Practice Address - Country:US
Practice Address - Phone:773-649-0760
Practice Address - Fax:224-205-3757
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IL1490204191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker