Provider Demographics
NPI:1275169732
Name:BIELACZYC, MACIEJ JAKUB (LCSW)
Entity Type:Individual
Prefix:
First Name:MACIEJ
Middle Name:JAKUB
Last Name:BIELACZYC
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2951
Mailing Address - Country:US
Mailing Address - Phone:312-926-0313
Mailing Address - Fax:312-695-5864
Practice Address - Street 1:676 N SAINT CLAIR ST STE 1400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2951
Practice Address - Country:US
Practice Address - Phone:312-926-0313
Practice Address - Fax:312-695-5864
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490160211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical