Provider Demographics
NPI:1487984431
Name:TILLMAN, LIARA MICAELA (LCSW)
Entity type:Individual
Prefix:
First Name:LIARA
Middle Name:MICAELA
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LIARA
Other - Middle Name:MICAELA
Other - Last Name:LEFTRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9697 191ST ST
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8609
Mailing Address - Country:US
Mailing Address - Phone:630-305-5027
Mailing Address - Fax:
Practice Address - Street 1:9697 191ST ST
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8609
Practice Address - Country:US
Practice Address - Phone:630-305-5027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14879844311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical