Provider Demographics
NPI:1841831286
Name:BOLOTIN, MEGAN GABRIELLE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:GABRIELLE
Last Name:BOLOTIN
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 1:239 APPLETREE LN
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3101
Mailing Address - Country:US
Mailing Address - Phone:847-924-0775
Mailing Address - Fax:
Practice Address - Street 1:239 APPLETREE LN
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-3101
Practice Address - Country:US
Practice Address - Phone:847-924-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0183961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical