Provider Demographics
NPI:1134652373
Name:ROBINSONMUHAMMAD, NECOLE KATRESE (LCSW, LSW)
Entity Type:Individual
Prefix:
First Name:NECOLE
Middle Name:KATRESE
Last Name:ROBINSONMUHAMMAD
Suffix:
Gender:F
Credentials:LCSW, LSW
Other - Prefix:
Other - First Name:NECOLE
Other - Middle Name:KATRESE
Other - Last Name:MUHAMMAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LSW
Mailing Address - Street 1:10428 S RHODES AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2938
Mailing Address - Country:US
Mailing Address - Phone:773-447-1145
Mailing Address - Fax:
Practice Address - Street 1:10428 S RHODES AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2938
Practice Address - Country:US
Practice Address - Phone:773-447-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.011291104100000X
IL149.0182171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker