Provider Demographics
NPI:1891144721
Name:KBREAB, BEYLUL
Entity Type:Individual
Prefix:
First Name:BEYLUL
Middle Name:
Last Name:KBREAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BELUL
Other - Middle Name:
Other - Last Name:GHEBREMICAEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:721 N. LASALLE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654
Mailing Address - Country:US
Mailing Address - Phone:708-329-4028
Mailing Address - Fax:
Practice Address - Street 1:721 N. LASALLE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654
Practice Address - Country:US
Practice Address - Phone:708-329-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150014972104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker