=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336215243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNA C. CLAFFEY M.S.W., L.C.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2006
-----------------------------------------------------
Last Update Date | 03/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 W EASTMAN ST STE 305
-----------------------------------------------------
City | ARLINGTON HTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60004-5950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-255-7704
-----------------------------------------------------
Fax | 847-639-3510
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 555 CARY WOODS CIR
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60013-2069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-516-4251
-----------------------------------------------------
Fax | 847-639-3510
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | IL 149-003665
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------