Provider Demographics
NPI:1316439037
Name:KOPLOW, AMELIA EADES (LCSW)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:EADES
Last Name:KOPLOW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:PHOEBE
Other - Last Name:EADES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:430 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2733
Mailing Address - Country:US
Mailing Address - Phone:312-305-9882
Mailing Address - Fax:
Practice Address - Street 1:3545 LAKE AVE STE 200
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1058
Practice Address - Country:US
Practice Address - Phone:847-251-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490098601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical