Provider Demographics
NPI:1043504426
Name:RAUBOLT, GARRETT (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:
Last Name:RAUBOLT
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 E ONTARIO ST STE 7-100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4418
Mailing Address - Country:US
Mailing Address - Phone:312-695-5060
Mailing Address - Fax:312-695-5010
Practice Address - Street 1:446 E ONTARIO ST STE 7-100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4418
Practice Address - Country:US
Practice Address - Phone:312-695-5060
Practice Address - Fax:312-695-5010
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490133551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty