Provider Demographics
NPI:1851745996
Name:ANNELIESE MOY, LCSW, LLC
Entity Type:Organization
Organization Name:ANNELIESE MOY, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORK
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNELIESE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-831-1876
Mailing Address - Street 1:1431 N CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1702
Mailing Address - Country:US
Mailing Address - Phone:708-831-1876
Mailing Address - Fax:
Practice Address - Street 1:1431 N CLAREMONT AVE
Practice Address - Street 2:2ND FL PAVILLION
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1702
Practice Address - Country:US
Practice Address - Phone:773-615-6538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNELIESE MOY, LCSW,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-14
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490129131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty