MEDICARE: RENE M SALVATORE 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	104100000X	Social Worker	149022249	IL

General Provider Information

NPI Number	:	1609483346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENE M SALVATORE LCSW

Provider Business Mailing Address
First Line	:	3434 N BELL AVE APT 1N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 N BELL AVE APT 1N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6002
Country	:	US
Telephone Number	:	973-901-4037
Fax Number	:

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

Provider Enumeration Date	:	09/27/2020
Last Update Date	:	09/27/2020

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