Provider Demographics
NPI:1699377457
Name:TRUBOW, LISA ERIN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ERIN
Last Name:TRUBOW
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 KINGSLEY CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5137
Mailing Address - Country:US
Mailing Address - Phone:847-924-9272
Mailing Address - Fax:
Practice Address - Street 1:1975 KINGSLEY CIR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5137
Practice Address - Country:US
Practice Address - Phone:847-924-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0253501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical