Provider Demographics
NPI:1104903327
Name:BUCHHOLZ, JAMES ROBERT (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:BUCHHOLZ
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 1:637 E GOLF RD
Mailing Address - Street 2:SUITE # 210
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4967
Mailing Address - Country:US
Mailing Address - Phone:847-228-6440
Mailing Address - Fax:847-359-8820
Practice Address - Street 1:637 E GOLF RD
Practice Address - Street 2:SUITE # 210
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4967
Practice Address - Country:US
Practice Address - Phone:847-228-6440
Practice Address - Fax:847-359-8820
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490017561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL940151Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER