Provider Demographics
NPI:1609956168
Name:ATKIN, JOHN ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANTHONY
Last Name:ATKIN
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 1:6912 MAIN ST STE 28
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3447
Mailing Address - Country:US
Mailing Address - Phone:630-235-4229
Mailing Address - Fax:630-545-2895
Practice Address - Street 1:6912 MAIN ST STE 28
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3447
Practice Address - Country:US
Practice Address - Phone:630-235-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL149-0020451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00416475556OtherBC/BS PROVIDER #
IL0002221807OtherBCBS PROVIDER #
IL530060Medicare PIN