Provider Demographics
NPI:1942445671
Name:INNOVATIVE SOCIAL WORK SOLUTIONS, P.C.
Entity Type:Organization
Organization Name:INNOVATIVE SOCIAL WORK SOLUTIONS, P.C.
Other - Org Name:ISWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:LUTHER
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:II
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-255-0672
Mailing Address - Street 1:233 E ERIE ST STE 610
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5934
Mailing Address - Country:US
Mailing Address - Phone:773-255-0672
Mailing Address - Fax:
Practice Address - Street 1:233 E ERIE ST STE 610
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5934
Practice Address - Country:US
Practice Address - Phone:773-255-0672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0110891041C0700X
IL20066061041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty