Provider Demographics
NPI:1386978823
Name:NOWAK, ERIN ELISABETH (BCBA, LCSW)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ELISABETH
Last Name:NOWAK
Suffix:
Gender:F
Credentials:BCBA, LCSW
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:ELISABETH
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:10402 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4704
Mailing Address - Country:US
Mailing Address - Phone:708-422-2898
Mailing Address - Fax:708-636-8778
Practice Address - Street 1:10402 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4704
Practice Address - Country:US
Practice Address - Phone:708-422-2898
Practice Address - Fax:708-636-8778
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.012271104100000X
IL1490146631041C0700X
IL1-18-33298103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical