Provider Demographics
NPI:1205049194
Name:THURMAN, ROBERT EMIL JR (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EMIL
Last Name:THURMAN
Suffix:JR
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 1:18303 ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2856
Mailing Address - Country:US
Mailing Address - Phone:773-419-8288
Mailing Address - Fax:312-575-1280
Practice Address - Street 1:330 W. 177TH STREET
Practice Address - Street 2:SUITE 1F
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60430-2184
Practice Address - Country:US
Practice Address - Phone:773-653-9467
Practice Address - Fax:773-799-1889
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0077531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL12278316OtherMULTIPLAN
IL1634964OtherBLUE CROSS BLUE SHIELD IL
IL521834OtherVALUEOPTIONS
IL55900COtherPSYCHEALTH
IL316653OtherMHN MANAGED HEALTH NETWOR
IL784444000OtherMAGELLAN
ILT9190OtherAPS
IL9367411OtherPHCS PRIVATE HEALTH CARE