Provider Demographics
NPI:1326410432
Name:CHMIEL, MATTHEW BRADEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:BRADEN
Last Name:CHMIEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:BRADEN
Other - Middle Name:
Other - Last Name:CHMIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:943 HANNAH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2309
Mailing Address - Country:US
Mailing Address - Phone:708-488-9556
Mailing Address - Fax:708-488-9556
Practice Address - Street 1:943 HANNAH AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2309
Practice Address - Country:US
Practice Address - Phone:708-488-9556
Practice Address - Fax:708-488-9556
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0123721041C0700X
IL6318281041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool