Healthcare Provider Details

I. General information

NPI: 1174604664
Provider Name (Legal Business Name): MICHAEL G. MCCANN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH AND ROOSEVELT AVENUE
HINES IL
60141
US

IV. Provider business mailing address

5TH AND ROOSEVELT AVENUE
HINES IL
60141
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2023
  • Fax: 708-202-2762
Mailing address:
  • Phone: 708-202-2023
  • Fax: 708-202-2762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.000391
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: