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NPI Code Detail

MEDICARE: MACAULEY CLIFFE LSW

MEDICARE: MACAULEY CLIFFE LSW
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
1104100000XSocial Worker150.103977IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1150.103977OTHERILLSW LICENSE

General Provider Information

NPI Number : 1790336311
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACAULEY CLIFFE LSW
Provider Business Mailing Address
First Line : 3808 N ASHLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60613-5382
Country : US
Telephone Number : 773-542-3128
Fax Number :
Provider Business Practice Location Address
First Line : 3808 N ASHLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60613-5382
Country : US
Telephone Number : 773-542-3128
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2019
Last Update Date : 09/25/2019

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Directions to “ MACAULEY CLIFFE LSW” Practice Location

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