7739956300

NPI: 1336685494 · Organization · Active

Primary Specialty

Clinical Social Worker
Social Worker — Clinical

Practice Location

1029 E 130TH ST
CHICAGO, IL 60628-6908 Map ↗
Phone: 773-995-6300
Fax: 773-995-6192

Mailing Address

1029 E.130TH STREET
CHICAGO, IL 60628 Map ↗
Phone: 773-995-6300
Fax: 773-995-6192

Used for billing & correspondence; clinical visits at the Practice Location above.

All Specialties & Licenses

  • Clinical Social Worker Primary — Clinical (license: 149018713, IL)

NPI Registration

Enumerated: 2017-01-13

Last CMS Update: 2017-01-13