Provider Demographics
NPI:1366507238
Name:BRESLOW, JULIAN WILLIAM (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:WILLIAM
Last Name:BRESLOW
Suffix:
Gender:M
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E CHESTNUT ST APT 4204
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2488
Mailing Address - Country:US
Mailing Address - Phone:312-337-0686
Mailing Address - Fax:312-337-0686
Practice Address - Street 1:260 E CHESTNUT ST APT 4204
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2488
Practice Address - Country:US
Practice Address - Phone:312-337-0686
Practice Address - Fax:312-337-0686
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001671256OtherBCBS PROVIDER NUMBER
0001671256OtherBCBS PROVIDER NUMBER