Provider Demographics
NPI:1932852969
Name:RUDNICK, AVI (LCSW)
Entity Type:Individual
Prefix:
First Name:AVI
Middle Name:
Last Name:RUDNICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5153 N CLARK ST STE 224
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6835
Mailing Address - Country:US
Mailing Address - Phone:312-620-9868
Mailing Address - Fax:
Practice Address - Street 1:5153 N CLARK ST STE 224
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-6835
Practice Address - Country:US
Practice Address - Phone:312-620-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0226981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty