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NPI Code Detail

MEDICARE: NICHOLAS PRESTON BARRY LSW

MEDICARE: NICHOLAS PRESTON BARRY LSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149.030912IL
2101YA0400XAddiction (Substance Use Disorder) Counselor
3104100000XSocial Worker150.111555IL
4101YP1600XPastoral Counselor

General Provider Information

NPI Number : 1003599077
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS PRESTON BARRY LSW
Provider Business Mailing Address
First Line : 16730 BEVERLY AVE
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-2951
Country : US
Telephone Number : 708-517-3120
Fax Number :
Provider Business Practice Location Address
First Line : 20550 S LA GRANGE RD STE 105
Second Line :
City : FRANKFORT
State : IL
Zip : 60423-1273
Country : US
Telephone Number : 331-758-7354
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2023
Last Update Date : 01/07/2026

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Directions to “ NICHOLAS PRESTON BARRY LSW” Practice Location

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