Provider Demographics
NPI:1518345818
Name:WEISMAN, ANDREW (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2833
Mailing Address - Country:US
Mailing Address - Phone:773-508-1000
Mailing Address - Fax:773-508-1112
Practice Address - Street 1:3003 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2833
Practice Address - Country:US
Practice Address - Phone:773-508-1000
Practice Address - Fax:773-508-1112
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490175631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical