Provider Demographics
NPI:1518373281
Name:HALLBERG, JAMES (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HALLBERG
Suffix:
Gender:M
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5306 N WINTHROP AVE
Mailing Address - Street 2:UNIT 2S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2374
Mailing Address - Country:US
Mailing Address - Phone:773-504-5930
Mailing Address - Fax:
Practice Address - Street 1:5306 N WINTHROP AVE
Practice Address - Street 2:UNIT 2S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2374
Practice Address - Country:US
Practice Address - Phone:773-504-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0167371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical