Provider Demographics
NPI:1942817259
Name:LISA BELGRAD LCSW PLLC
Entity Type:Organization
Organization Name:LISA BELGRAD LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF S-CORP
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELGRAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-638-9718
Mailing Address - Street 1:811 CHICAGO AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2392
Mailing Address - Country:US
Mailing Address - Phone:708-638-9718
Mailing Address - Fax:
Practice Address - Street 1:630 VERNON AVE
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1681
Practice Address - Country:US
Practice Address - Phone:708-638-9718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty