Provider Demographics
NPI:1508226911
Name:EL, WORSHAM CC (AM, LCSW, CFTP)
Entity Type:Individual
Prefix:MS
First Name:WORSHAM
Middle Name:CC
Last Name:EL
Suffix:
Gender:F
Credentials:AM, LCSW, CFTP
Other - Prefix:
Other - First Name:CHAUNTAY
Other - Middle Name:
Other - Last Name:BRENORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 E 79TH ST APT 315
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-2849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2151 W 79TH ST STE 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-5723
Practice Address - Country:US
Practice Address - Phone:312-757-0608
Practice Address - Fax:773-952-2025
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149018288101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health