Provider Demographics
NPI:1558404525
Name:NORTHROP, PAMELA WEINER (MA LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:WEINER
Last Name:NORTHROP
Suffix:
Gender:F
Credentials:MA LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5415
Mailing Address - Country:US
Mailing Address - Phone:773-643-7535
Mailing Address - Fax:
Practice Address - Street 1:1400 E 54TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5415
Practice Address - Country:US
Practice Address - Phone:773-885-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490002191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical