Provider Demographics
NPI:1386477230
Name:MILLWARD, ENA ISIS (LCSW)
Entity type:Individual
Prefix:
First Name:ENA
Middle Name:ISIS
Last Name:MILLWARD
Suffix:
Gender:U
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 N RUTHERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3942
Mailing Address - Country:US
Mailing Address - Phone:773-707-6093
Mailing Address - Fax:
Practice Address - Street 1:1719 N RUTHERFORD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3942
Practice Address - Country:US
Practice Address - Phone:773-707-6093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-24
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0275791041C0700X
VT089.0136253TELE1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical