Provider Demographics
NPI:1144797440
Name:CHARLES F SMALL LCSW LLC
Entity Type:Organization
Organization Name:CHARLES F SMALL LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-307-1045
Mailing Address - Street 1:1465 W GRAND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-8532
Mailing Address - Country:US
Mailing Address - Phone:773-307-1045
Mailing Address - Fax:
Practice Address - Street 1:1465 W GRAND AVE APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-8532
Practice Address - Country:US
Practice Address - Phone:773-307-1045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.015676OtherPROFESSIONAL LICENSE