Provider Demographics
NPI:1912567678
Name:TRAYANOV, MOMCHIL H (LCSW)
Entity Type:Individual
Prefix:
First Name:MOMCHIL
Middle Name:H
Last Name:TRAYANOV
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 1:10369 DEARLOVE RD APT 2G
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3623
Mailing Address - Country:US
Mailing Address - Phone:847-501-1141
Mailing Address - Fax:
Practice Address - Street 1:6155 GRAND AVE STE 210
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1651
Practice Address - Country:US
Practice Address - Phone:847-535-6489
Practice Address - Fax:847-535-7655
Is Sole Proprietor?:No
Enumeration Date:2019-06-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490213141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical