Healthcare Provider Details

I. General information

NPI: 1326537747
Provider Name (Legal Business Name): DANIEL J MELOY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W LAWRENCE AVE FL 2
CHICAGO IL
60640-5017
US

IV. Provider business mailing address

4809 N DAMEN AVE APT 3N
CHICAGO IL
60625-1481
US

V. Phone/Fax

Practice location:
  • Phone: 773-275-2586
  • Fax:
Mailing address:
  • Phone: 414-534-4602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.019478
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: