Provider Demographics
NPI:1548770936
Name:FRIEDLAND, AVITAL (LCSW)
Entity Type:Individual
Prefix:
First Name:AVITAL
Middle Name:
Last Name:FRIEDLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 N WILTON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1941
Mailing Address - Country:US
Mailing Address - Phone:574-329-4162
Mailing Address - Fax:
Practice Address - Street 1:3511 N WILTON AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1941
Practice Address - Country:US
Practice Address - Phone:574-329-4162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0222241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF634-0029-1972OtherDRIVER'S LICENSE