MEDICARE: ZANGRILLI COUNSELING

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

General Provider Information

NPI Number	:	1306476361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZANGRILLI COUNSELING

Provider Business Mailing Address
First Line	:	5007 N WINCHESTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2614
Country	:	US
Telephone Number	:	847-226-3036
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 N RAVENSWOOD AVE STE 105
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5945
Country	:	US
Telephone Number	:	847-226-3036
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. STEPHANIE ZANGRILLI
Credential	:	LCSW
Telephone Number	:	847-226-3036

Provider Enumeration Date	:	01/17/2020
Last Update Date	:	01/17/2020

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