Provider Demographics
NPI:1700955226
Name:EMKIN, IRA DAVID (LCSW)
Entity Type:Individual
Prefix:MR
First Name:IRA
Middle Name:DAVID
Last Name:EMKIN
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 1:990 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1768
Mailing Address - Country:US
Mailing Address - Phone:847-446-8560
Mailing Address - Fax:
Practice Address - Street 1:990 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1768
Practice Address - Country:US
Practice Address - Phone:847-446-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201156Medicare ID - Type Unspecified