Provider Demographics
NPI:1750396289
Name:FAMILY SERVICE CENTER OF WILMETTE GLENVIEW NORTHBROOK KENILWORTH
Entity type:Organization
Organization Name:FAMILY SERVICE CENTER OF WILMETTE GLENVIEW NORTHBROOK KENILWORTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-251-7350
Mailing Address - Street 1:191 WAUKEGAN RD STE 206
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2743
Mailing Address - Country:US
Mailing Address - Phone:847-251-7350
Mailing Address - Fax:847-853-2600
Practice Address - Street 1:191 WAUKEGAN RD STE 206
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2743
Practice Address - Country:US
Practice Address - Phone:847-251-7350
Practice Address - Fax:847-853-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X, 1041C0700X, 106H00000X
IN103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1605635OtherBLUE CROSS BLUE SHIELD
IL990230Medicare ID - Type Unspecified