Provider Demographics
NPI:1184674731
Name:MALM, ERIC CHRISTOPHER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:CHRISTOPHER
Last Name:MALM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3401 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4426
Mailing Address - Country:US
Mailing Address - Phone:773-282-9845
Mailing Address - Fax:773-282-9847
Practice Address - Street 1:3401 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4426
Practice Address - Country:US
Practice Address - Phone:773-282-9845
Practice Address - Fax:773-282-9847
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149011241104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1386961886OtherCHICAGO RESEARCH CENTER, INC.