Provider Demographics
NPI:1104961473
Name:O'HARA, ED DREW (LCSW)
Entity type:Individual
Prefix:MR
First Name:ED
Middle Name:DREW
Last Name:O'HARA
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 1:9031 EWING AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1908
Mailing Address - Country:US
Mailing Address - Phone:847-329-1293
Mailing Address - Fax:
Practice Address - Street 1:1700 LUTHER LN
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1270
Practice Address - Country:US
Practice Address - Phone:847-723-7321
Practice Address - Fax:847-723-6577
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical