MEDICARE: ROBERT HAROLD DARGEL MSW, LCSW, CEAP

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	149.011190	IL

General Provider Information

NPI Number	:	1154561306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT HAROLD DARGEL MSW, LCSW, CEAP

Provider Business Mailing Address
First Line	:	2547 W GUNNISON ST
Second Line	:	FLOOR 2
City	:	CHICAGO
State	:	IL
Zip	:	60625-2813
Country	:	US
Telephone Number	:	773-841-6450
Fax Number	:	773-728-1990

Provider Business Practice Location Address
First Line	:	2547 W GUNNISON ST
Second Line	:	FLOOR 2
City	:	CHICAGO
State	:	IL
Zip	:	60625-2813
Country	:	US
Telephone Number	:	773-841-6450
Fax Number	:	773-728-1990

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

Provider Enumeration Date	:	03/01/2009
Last Update Date	:	03/01/2009

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