Provider Demographics
NPI:1891018644
Name:GILLIGAN, JAMES MATTHEW (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MATTHEW
Last Name:GILLIGAN
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 1:1009 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3249
Mailing Address - Country:US
Mailing Address - Phone:630-710-8226
Mailing Address - Fax:
Practice Address - Street 1:0S125 CHURCH ST
Practice Address - Street 2:SUITE # 3
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1242
Practice Address - Country:US
Practice Address - Phone:630-710-8226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490134011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical