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NPI Code Detail

MEDICARE: AMY JO CATES LCSW

MEDICARE: AMY JO CATES 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 Worker

General Provider Information

NPI Number : 1518495985
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY JO CATES LCSW
Provider Business Mailing Address
First Line : 3600 S WATER TOWER PL
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-6589
Country : US
Telephone Number : 618-244-0212
Fax Number : 618-244-0535
Provider Business Practice Location Address
First Line : 3600 S WATER TOWER PL
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-6589
Country : US
Telephone Number : 618-244-0212
Fax Number : 618-244-0535
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2017
Last Update Date : 05/31/2017

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