Provider Demographics
NPI:1932571841
Name:JACQUELINE HERBSTMAN, LCSW, P.C.
Entity Type:Organization
Organization Name:JACQUELINE HERBSTMAN, LCSW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBSTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-307-9887
Mailing Address - Street 1:1770 W BERTEAU AVE
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1770 W BERTEAU AVE
Practice Address - Street 2:SUITE 302A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1849
Practice Address - Country:US
Practice Address - Phone:312-307-9887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490138101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty