MEDICARE: MR. PATRICK H. HOULIHAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149-009891	IL

General Provider Information

NPI Number	:	1013247527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK H. HOULIHAN LCSW

Provider Business Mailing Address
First Line	:	1131 W LUNT AVE
Second Line	:	APT 105
City	:	CHICAGO
State	:	IL
Zip	:	60626-3532
Country	:	US
Telephone Number	:	773-743-1441
Fax Number	:

Provider Business Practice Location Address
First Line	:	1131 W LUNT AVE
Second Line	:	APT 105
City	:	CHICAGO
State	:	IL
Zip	:	60626-3532
Country	:	US
Telephone Number	:	773-743-1441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	01/05/2010

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