MEDICARE: MS. ANGELA M. FADRAGAS M.S.W.

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
1	1041C0700X	Clinical Social Worker	149-006023	IL
2	104100000X	Social Worker	149006023	IL

General Provider Information

NPI Number	:	1063460350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA M. FADRAGAS M.S.W.

Provider Business Mailing Address
First Line	:	2201 LAKESIDE DR
Second Line	:
City	:	BANNOCKBURN
State	:	IL
Zip	:	60015-1265
Country	:	US
Telephone Number	:	312-547-1931
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 LAKESIDE DR
Second Line	:
City	:	BANNOCKBURN
State	:	IL
Zip	:	60015-1265
Country	:	US
Telephone Number	:	312-547-1931
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	04/05/2023

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