Provider Demographics
NPI:1558028928
Name:EMRICH, ELEANOR (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:
Last Name:EMRICH
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 1:4411 N RAVENSWOOD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5802
Mailing Address - Country:US
Mailing Address - Phone:847-873-4010
Mailing Address - Fax:
Practice Address - Street 1:4411 N RAVENSWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5802
Practice Address - Country:US
Practice Address - Phone:847-873-4010
Practice Address - Fax:847-780-3360
Is Sole Proprietor?:No
Enumeration Date:2021-11-20
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490238631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical