Provider Demographics
NPI:1033323464
Name:CAGWIN, JOEL JB (MA)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:JB
Last Name:CAGWIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3S261 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-2629
Mailing Address - Country:US
Mailing Address - Phone:630-365-0899
Mailing Address - Fax:630-365-9150
Practice Address - Street 1:106 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119-8201
Practice Address - Country:US
Practice Address - Phone:630-365-0899
Practice Address - Fax:630-365-9150
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional