Provider Demographics
NPI:1629102199
Name:FRACHALLA, BARBARA BOSWELL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:BOSWELL
Last Name:FRACHALLA
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 1:120 LAKEVIEW DR APT 321
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1141
Mailing Address - Country:US
Mailing Address - Phone:630-307-0731
Mailing Address - Fax:630-307-0733
Practice Address - Street 1:120 LAKEVIEW DR APT 321
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1141
Practice Address - Country:US
Practice Address - Phone:630-307-0731
Practice Address - Fax:630-307-0733
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02233054OtherBLUE CROSS BLUE SHIELD