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General NPI Number Information
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NPI Number | 1114057346
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Entity Type | Individual
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Provider Name | LAWRENCE MICHAEL RUFFOLO L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 11/26/2008
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Provider Practice Location Address
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Address Line | 55 E WASHINGTON ST SUITE 2900
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City | CHICAGO
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State | IL
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Zip | 60602-2103
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Country | US
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Telephone | 847-338-2564
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Fax | 312-906-5199
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Provider Business Mailing Address
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Address Line | 2407 HARTREY AVE
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City | EVANSTON
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State | IL
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Zip | 60201-2562
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Country | US
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Telephone | 847-338-2564
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Fax | 312-906-5199
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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 | 149-002335
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License Number State | IL
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