Obrain U Agwanihu – Clinical Social Worker

Key facts

NPI: 1841997889
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: 149.027628 (IL)
Practice address: 622 Davis St Ste 200
Evanston, IL 60201-4491
Phone: (773) 294-0176
NPI assigned: Feb 9, 2023
Sex: Male
Sole proprietor: Yes

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Mildcare Behavioral Health Solution LLC Clinical Social Worker · Williamsburg, VA · NPI 1225927080

Medicare reassignment NPD CLINICAL · VA
Polina Reyngold, LTD Professional Counselor · Evanston, IL · NPI 1649644071

NPD (past)
Pearsall Counseling Services LCSW Community/Behavioral Health Agency · Freeport, NY · NPI 1205579448

NPD (past)

Medicare Care Compare profile

Specialty: Clinical Social Worker
Education: Other, 2015
Medicare assignment: May accept Medicare assignment

Practice addresses (Care Compare)

105 Pearsall Ave
Freeport, NY 11520-2618

Medicare participation

Medicare fee-for-service enrollment: Enrolled in VA
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20251028003856	VA	Practitioner - Clinical Social Worker	8921597188	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
150.110303	IL	MD	Social Worker
149.027628	IL	MD	Clinical Social Worker

Practice roles

Organization	Specialty	Status	New patients
Mildcare Behavioral Health Solution LLC	Clinical	Current since Jun 27, 2025	Accepting new patients
Pearsall Counseling Services LCSW		Past since Apr 17, 2022	Accepting new patients
Polina Reyngold, LTD		Past since Feb 12, 2023	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Social Worker	104100000X	150.110303	IL
Clinical Social Worker	1041C0700X	149.027628	IL	Yes

Addresses

Primary practice location

622 Davis St Ste 200
Evanston, IL 60201-4491

Mailing address

128 Bixley Heath
Lynbrook, NY 11563-3140
Phone (516) 574-1018

Other practice location 1

105 Pearsall Ave
Freeport, NY 11520-2618
Phone (516) 574-1018

Other providers in Evanston, IL

All providers in Evanston, IL · Clinical Social Worker in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.