Provider Demographics
NPI:1801321542
Name:CAMP, LILY (LCSW)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:CAMP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4753 N BROADWAY ST STE 925
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4991
Mailing Address - Country:US
Mailing Address - Phone:773-989-2780
Mailing Address - Fax:
Practice Address - Street 1:4753 N BROADWAY ST STE 925
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4991
Practice Address - Country:US
Practice Address - Phone:773-989-2780
Practice Address - Fax:773-989-2781
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490184621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical