MEDICARE: MISS FRA ANGELICA S FARINAS 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
1	101YM0800X	Mental Health Counselor		IL

General Provider Information

NPI Number	:	1417146671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS FRA ANGELICA S FARINAS LCSW

Provider Business Mailing Address
First Line	:	6456 N MOZART ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-5224
Country	:	US
Telephone Number	:	773-615-1598
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7391
Country	:	US
Telephone Number	:	773-615-1598
Fax Number	:

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

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/23/2007

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