Provider Demographics
NPI:1851712392
Name:OBRADOVICH, ERIN DANIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:DANIELLE
Last Name:OBRADOVICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N. RAVENSWOOD AVE.
Mailing Address - Street 2:SUITE 231
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1710
Mailing Address - Country:US
Mailing Address - Phone:630-935-8107
Mailing Address - Fax:773-661-4762
Practice Address - Street 1:5100 N. RAVENSWOOD AVE.
Practice Address - Street 2:SUITE 231
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1710
Practice Address - Country:US
Practice Address - Phone:630-935-8107
Practice Address - Fax:773-661-4762
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-31
Last Update Date:2015-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.014702104100000X
IL149.0179931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker