Provider Demographics
NPI:1700231628
Name:DRELL, ROBIN (LSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:DRELL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 N CAMBRIDGE AVE
Mailing Address - Street 2:#504
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2828 N CAMBRIDGE AVE
Practice Address - Street 2:#504
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6004
Practice Address - Country:US
Practice Address - Phone:847-421-6942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0194911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical