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General NPI Number Information
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NPI Number | 1285913491
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Entity Type | Organization
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Legal Business Name | RDS - SERVICES LTD
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 1600 WESTCHESTER BLVD
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City | WESTCHESTER
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State | IL
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Zip | 60154-4362
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Country | US
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Telephone | 708-574-8980
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Fax |
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Provider Business Mailing Address
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Address Line | 1859 BUCKINGHAM AVE
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City | WESTCHESTER
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State | IL
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Zip | 60154-4268
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Country | US
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Telephone | 708-409-0976
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT DAVID SMOLA
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Credential | LCSW
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Telephone | 708-574-8980
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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 | 149.009477
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License Number State | IL
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