Ethan Israelsohn, LCSW, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149-007781 Issued in IL

Legal business name

ETHAN ISRAELSOHN, LCSW, LLC

Practice address

715 Lake St
Suite 710
Oak Park, IL 60301-1422

Phone

(708) 848-0112

Fax

(708) 386-4211

NPI assigned

Jan 10, 2007

Last updated

Sep 3, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ethan Israelsohn, LCSWNPI 1265504864

Title

Owner

Phone

(708) 848-0112

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ethan Israelsohn, LCSW

  • Clinical Social Worker
  • Oak Park, IL
  • NPI 1265504864

  VA

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599091200000",
    "number": "1528118072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 HIGHLAND AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603041523",
            "telephone_number": "708-848-0112",
            "fax_number": "708-386-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 LAKE ST",
            "address_2": "SUITE 710",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011422",
            "telephone_number": "708-848-0112",
            "fax_number": "708-386-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHAN ISRAELSOHN, LCSW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A",
        "authorized_official_last_name": "ISRAELSOHN",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-848-0112",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149-007781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.