Healthcare Provider Details

I. General information

NPI: 1760457287
Provider Name (Legal Business Name): FREDERICK J MACRAE L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3257 N SHEFFIELD AVE SUITE# 119
CHICAGO IL
60657-2270
US

IV. Provider business mailing address

2575 W ARGYLE ST
CHICAGO IL
60625-2603
US

V. Phone/Fax

Practice location:
  • Phone: 773-528-8477
  • Fax: 773-728-7748
Mailing address:
  • Phone: 773-528-8477
  • Fax: 773-728-7748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: