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NPI Code Detail

MEDICARE: MR. DENNIS ANTHONY BEAUCHAMP LCSW

MEDICARE:  MR. DENNIS ANTHONY BEAUCHAMP  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 WorkerIL

General Provider Information

NPI Number : 1912926528
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DENNIS ANTHONY BEAUCHAMP LCSW
Provider Business Mailing Address
First Line : 2834 W RASCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-3214
Country : US
Telephone Number : 773-989-0466
Fax Number :
Provider Business Practice Location Address
First Line : 3003 W. TOUHY AVE.
Second Line : COUNCIL FOR JEWISH ELDERLY
City : CHICAGO
State : IL
Zip : 60645
Country : US
Telephone Number : 773-508-1139
Fax Number : 773-262-7084
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 07/09/2007

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Directions to “ MR. DENNIS ANTHONY BEAUCHAMP LCSW” Practice Location

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