Basic Information
| Provider Information | |||||||||
| NPI: | 1003806548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZABIN | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4043 SUFFIELD CT | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476773055 | ||||||||
| FaxNumber: | 8473299316 | ||||||||
| Practice Location | |||||||||
| Address1: | 9701 KNOX AVE | ||||||||
| Address2: | 214 | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476773055 | ||||||||
| FaxNumber: | 8473299316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.