Provider Demographics
NPI:1972150712
Name:MORAN, EDITH (LCSW)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EVERETT
Other - Middle Name:
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4000 W MONTROSE AVE # 528
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2140
Mailing Address - Country:US
Mailing Address - Phone:312-835-7286
Mailing Address - Fax:
Practice Address - Street 1:4000 W MONTROSE AVE # 528
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2140
Practice Address - Country:US
Practice Address - Phone:312-835-7286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0195791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical