Provider Demographics
NPI:1578300711
Name:NOEL, PHYLICIA K (LCSW)
Entity type:Individual
Prefix:MISS
First Name:PHYLICIA
Middle Name:K
Last Name:NOEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 S LAKE PARK AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-1482
Mailing Address - Country:US
Mailing Address - Phone:773-724-7021
Mailing Address - Fax:
Practice Address - Street 1:3650 S LAKE PARK AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-1482
Practice Address - Country:US
Practice Address - Phone:773-724-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0271081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical