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NPI Code Detail

MEDICARE: MARTYNAS AUKSTUOLIS LCSW

MEDICARE: MARTYNAS AUKSTUOLIS 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 Worker149013972IL

General Provider Information

NPI Number : 1790346526
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTYNAS AUKSTUOLIS LCSW
Provider Business Mailing Address
First Line : 718 EAST ST
Second Line :
City : LEMONT
State : IL
Zip : 60439-4203
Country : US
Telephone Number : 773-633-1806
Fax Number :
Provider Business Practice Location Address
First Line : 120 W 26TH ST
Second Line :
City : SOUTH CHICAGO HEIGHTS
State : IL
Zip : 60411-4141
Country : US
Telephone Number : 708-756-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2019
Last Update Date : 06/24/2019

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Directions to “ MARTYNAS AUKSTUOLIS LCSW” Practice Location

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