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General NPI Number Information
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NPI Number | 1134521453
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Entity Type | Organization
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Legal Business Name | CENTER FOR RECOVERY & GROWTH, LLC
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Dates
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Enumeration Date | 09/17/2014
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 1770 W BERTEAU AVE STE 302A
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City | CHICAGO
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State | IL
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Zip | 60613-1750
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Country | US
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Telephone | 773-850-0526
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Fax |
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Provider Business Mailing Address
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Address Line | 1628 W GREGORY ST
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City | CHICAGO
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State | IL
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Zip | 60640-1108
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Country | US
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Telephone | 312-848-5626
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | BARBARA HERMAN BAYNE
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Credential | LCSW
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Telephone | 312-848-5626
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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 | 149.015422
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License Number State | IL
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