Provider Demographics
NPI:1790336758
Name:MUSCOLINO, LAUREN (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MUSCOLINO
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MUSCOLINO
Other - Last Name:ELDRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, CADC
Mailing Address - Street 1:265 E GRANTLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2444
Mailing Address - Country:US
Mailing Address - Phone:773-450-5756
Mailing Address - Fax:
Practice Address - Street 1:1100 JORIE BLVD STE 132
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4402
Practice Address - Country:US
Practice Address - Phone:630-522-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0214541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.021454OtherLCSW