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NPI Code Detail

MEDICARE: LIARA MICAELA TILLMAN LCSW

MEDICARE:   LIARA MICAELA TILLMAN  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 Worker1487984431IL

General Provider Information

NPI Number : 1487984431
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIARA MICAELA TILLMAN LCSW
Provider Business Mailing Address
First Line : 9697 191ST ST
Second Line :
City : MOKENA
State : IL
Zip : 60448-8609
Country : US
Telephone Number : 630-305-5027
Fax Number :
Provider Business Practice Location Address
First Line : 9697 191ST ST
Second Line :
City : MOKENA
State : IL
Zip : 60448-8609
Country : US
Telephone Number : 630-305-5027
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2010
Last Update Date : 05/07/2021

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Directions to “ LIARA MICAELA TILLMAN LCSW” Practice Location

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