Provider Demographics
NPI:1780736843
Name:PEARSON, MICHAEL J (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 ELA RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-6305
Mailing Address - Country:US
Mailing Address - Phone:847-438-5336
Mailing Address - Fax:847-540-0958
Practice Address - Street 1:765 ELA RD
Practice Address - Street 2:SUITE 211
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-6305
Practice Address - Country:US
Practice Address - Phone:847-438-5336
Practice Address - Fax:847-540-0958
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490044491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2154749OtherAETNA PROVIDER #
TX0005204094OtherAETNA PIN
MD05959OtherCIGNA BEHAVIORAL HEALTH #
IL0004932116OtherBLUE CROSS BLUE SHIELD PN
MD05959OtherCIGNA BEHAVIORAL HEALTH #