Provider Demographics
NPI:1982884052
Name:PHILLIP ELBAUM LCSW
Entity Type:Organization
Organization Name:PHILLIP ELBAUM LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:ELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-948-8696
Mailing Address - Street 1:35 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5053
Mailing Address - Country:US
Mailing Address - Phone:847-948-8696
Mailing Address - Fax:847-948-8707
Practice Address - Street 1:35 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5053
Practice Address - Country:US
Practice Address - Phone:847-948-8696
Practice Address - Fax:847-948-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004972087OtherBLUE CROSS/BLUE SHIELD
IL214304Medicare Oscar/Certification