Provider Demographics
NPI:1326767583
Name:LUBIS, MILLA (LSW)
Entity Type:Individual
Prefix:
First Name:MILLA
Middle Name:
Last Name:LUBIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 S MINERVA AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-4397
Mailing Address - Country:US
Mailing Address - Phone:630-708-8945
Mailing Address - Fax:
Practice Address - Street 1:1806 W CUYLER AVE STE 3E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2541
Practice Address - Country:US
Practice Address - Phone:630-708-8945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.108779104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker