Provider Demographics
NPI:1841782489
Name:BENJAMIN FOGEL, LCSW, LLC
Entity Type:Organization
Organization Name:BENJAMIN FOGEL, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-478-3999
Mailing Address - Street 1:53 W JACKSON BLVD STE 841
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3828
Mailing Address - Country:US
Mailing Address - Phone:312-478-3999
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 841
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3828
Practice Address - Country:US
Practice Address - Phone:312-478-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty