Provider Demographics
NPI:1154457968
Name:SMITH, ROBIN MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 N KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5028
Mailing Address - Country:US
Mailing Address - Phone:312-540-0319
Mailing Address - Fax:312-540-0315
Practice Address - Street 1:151 N MICHIGAN AVE
Practice Address - Street 2:SUSITE 911
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7506
Practice Address - Country:US
Practice Address - Phone:312-540-0319
Practice Address - Fax:312-540-0315
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1626465OtherBLUE CROSS
IL1626465OtherBLUE CROSS