Provider Demographics
NPI:1689189078
Name:JOHN BOZEDAY LCSW LTD
Entity Type:Organization
Organization Name:JOHN BOZEDAY LCSW LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOZEDAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-251-0346
Mailing Address - Street 1:235 RIDGE RD APT 4C
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3252
Mailing Address - Country:US
Mailing Address - Phone:847-251-0346
Mailing Address - Fax:847-251-0346
Practice Address - Street 1:708 CHURCH ST STE 258
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3840
Practice Address - Country:US
Practice Address - Phone:847-251-0346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490030051041C0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty