Provider Demographics
NPI:1407419195
Name:BRIAN DRELICHARZ, LCSW, LLC
Entity Type:Organization
Organization Name:BRIAN DRELICHARZ, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRELICHARZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-791-8274
Mailing Address - Street 1:5615 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-2206
Mailing Address - Country:US
Mailing Address - Phone:847-791-8274
Mailing Address - Fax:
Practice Address - Street 1:82 S LA GRANGE RD STE 210
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6348
Practice Address - Country:US
Practice Address - Phone:708-505-5480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty