Provider Demographics
NPI:1770630923
Name:MARK, JOSHUA F (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:F
Last Name:MARK
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 1:545 LINCOLN AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2349
Mailing Address - Country:US
Mailing Address - Phone:847-441-8323
Mailing Address - Fax:847-441-4993
Practice Address - Street 1:545 LINCOLN AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2349
Practice Address - Country:US
Practice Address - Phone:847-441-8323
Practice Address - Fax:847-441-4993
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
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