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NPI Code Detail

MEDICARE: MR. THOMAS PATRICK THARAYIL LCSW

MEDICARE: MR. THOMAS PATRICK THARAYIL LCSW
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 WorkerIL

General Provider Information

NPI Number : 1104930577
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS PATRICK THARAYIL LCSW
Provider Business Mailing Address
First Line : 30 N MICHIGAN AVE STE 901
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3767
Country : US
Telephone Number : 312-409-7014
Fax Number : 773-465-8832
Provider Business Practice Location Address
First Line : 30 N MICHIGAN AVE STE 901
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3767
Country : US
Telephone Number : 312-409-7014
Fax Number : 773-465-8832
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 07/08/2007

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