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General NPI Number Information
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NPI Number | 1356936488
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Entity Type | Individual
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Provider Name | ANDREW PATRICK HAZZARD LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/01/2021
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 1525 E 53RD ST STE 602
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City | CHICAGO
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State | IL
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Zip | 60615-4551
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Country | US
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Telephone | 312-612-0497
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Fax |
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Provider Business Mailing Address
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Address Line | 429 W 103RD ST
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City | CHICAGO
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State | IL
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Zip | 60628-2401
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Country | US
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Telephone | 302-531-5801
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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 | 149023043
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License Number State | IL
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