Healthcare Provider Details

I. General information

NPI: 1134521453
Provider Name (Legal Business Name): CENTER FOR RECOVERY & GROWTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 W BERTEAU AVE STE 302A
CHICAGO IL
60613-1750
US

IV. Provider business mailing address

1628 W GREGORY ST
CHICAGO IL
60640-1108
US

V. Phone/Fax

Practice location:
  • Phone: 773-850-0526
  • Fax:
Mailing address:
  • Phone: 312-848-5626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.015422
License Number StateIL

VIII. Authorized Official

Name: BARBARA HERMAN BAYNE
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 312-848-5626