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General NPI Number Information
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NPI Number | 1043549066
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Entity Type | Individual
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Provider Name | PATRICIA ANTHONY MACCLARENCE LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/22/2009
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 7101 S EXCHANGE AVE
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City | CHICAGO
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State | IL
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Zip | 60649-2503
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Country | US
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Telephone | 773-702-4269
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Fax | 773-702-4144
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Provider Business Mailing Address
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Address Line | 5240 S GREENWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60615-4316
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Country | US
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Telephone | 773-288-2394
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.009347
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License Number State | IL
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