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NPI Code Detail

MEDICARE: MR. BRENDAN JAMES RIORDAN LCSW

MEDICARE: MR. BRENDAN JAMES RIORDAN 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 Worker149013471IL

General Provider Information

NPI Number : 1831258037
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRENDAN JAMES RIORDAN LCSW
Provider Business Mailing Address
First Line : 5220 EAST AVE
Second Line :
City : COUNTRYSIDE
State : IL
Zip : 60525-3133
Country : US
Telephone Number : 708-745-5277
Fax Number :
Provider Business Practice Location Address
First Line : 6918 WINDSOR AVE
Second Line : PILLARS FILLMORE CENTER
City : BERWYN
State : IL
Zip : 60402
Country : US
Telephone Number : 708-995-3619
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2006
Last Update Date : 08/06/2024

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