Provider Demographics
NPI:1134551948
Name:EJUPOVIC, NAIRA (LSW)
Entity type:Individual
Prefix:
First Name:NAIRA
Middle Name:
Last Name:EJUPOVIC
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 GREENBAY RD
Mailing Address - Street 2:200
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 GREENBAY RD
Practice Address - Street 2:200
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2597
Practice Address - Country:US
Practice Address - Phone:847-251-6630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.014185104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker