Provider Demographics
NPI:1295886513
Name:VAN ZEYL, ROMAINE A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ROMAINE
Middle Name:A
Last Name:VAN ZEYL
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 1:135 N GREENLEAF ST
Mailing Address - Street 2:SUITE 228
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3393
Mailing Address - Country:US
Mailing Address - Phone:847-263-5872
Mailing Address - Fax:847-263-5550
Practice Address - Street 1:135 N GREENLEAF ST
Practice Address - Street 2:SUITE 228
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3393
Practice Address - Country:US
Practice Address - Phone:847-263-5872
Practice Address - Fax:847-263-5550
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0061271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-4061919OtherEID