Provider Demographics
NPI:1972341774
Name:RELMAN, ERIC SAMUEL
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:SAMUEL
Last Name:RELMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ELLI
Other - Middle Name:D
Other - Last Name:RELMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6514 N GLENWOOD AVE APT 3W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-7609
Mailing Address - Country:US
Mailing Address - Phone:216-527-8654
Mailing Address - Fax:
Practice Address - Street 1:840 W IRVING PARK RD STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3011
Practice Address - Country:US
Practice Address - Phone:773-659-9207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUC820665104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker