Provider Demographics
NPI:1215150412
Name:PAHWA, PREM K (LCSW)
Entity type:Individual
Prefix:MR
First Name:PREM
Middle Name:K
Last Name:PAHWA
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 1:2821 W GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2913
Mailing Address - Country:US
Mailing Address - Phone:773-919-2919
Mailing Address - Fax:
Practice Address - Street 1:203 N WABASH AVE
Practice Address - Street 2:SUITE 701
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-2406
Practice Address - Country:US
Practice Address - Phone:773-919-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
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
IL202474Medicare ID - Type Unspecified